Treatment of cardiogenic shock with nitroglycerin infusion and high-frequency positive pressure ventilation

A patient with chronic obstructive lung disease developed severe cardiopulmonary failure following acute myocardial infarction. High frequency positive pressure ventilation achieved good ventilation. The hemodynamic status was markedly improved when, in addition to dopamine, nitroglycerin was infused into the pulmonary artery. Within 24 h the cardiac index increased, and mean pulmonary artery pressure and pulmonary vascular resistance decreased. Pulmonary wedge pressure decreased more slowly than the pulmonary artery pressure and to a lesser extent. This critically ill patient responded very well to the treatment and was discharged in good health after 18 days in the General Intensive Care Unit. Intravenous nitroglycerin is a promising drug for the treatment of severe cardiopulmonary emergencies and should be tried in patients with chronic lung disease and acute cardiac or respiratory failure.