Sublingual nitroglycerin in the treatment of left ventricular failure and pulmonary edema

In 15 patients with left heart failure due to coronary heart disease (10 acute and 5 old infarcts) the enddiastolic pressures in the pulmonary artery (left ventricular filling pressure) were elevated to 25 +/- 8 mm Hg and signs of pulmonary congestion were present. After nitroglycerin sublingually (0.8-1.6 mg) the left ventricular filling pressure fell to 17 +/- 8 mm Hg and caridac output tended to increase. Mean arterial pressure did not change significantly. In 6 patients with pulmonary edema, clinically an impressive improvement was observed within 5-15 min after administration of the drug. In 1 case the left ventricular filling pressure decreased from 50 to 27 mm Hg within 5 min. In left heart failure, especially in the presence of pulmonary edema, sublingual nitroglycerin is a potent drug with a favorable influence on hemodynamic and clinical parameters.