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[Cardiac failure and nitrates]

M Galinier1, J P Bounhoure

  • 1Service de Cardiologie Clinique et Expérimentale, CHU Rangueil, Toulouse.

Annales De Cardiologie Et D'Angeiologie
|July 1, 1997
PubMed
Summary

Nitrates offer hemodynamic benefits in acute heart failure by reducing pressures. However, chronic use shows diminishing effects, with combination therapy showing improved survival but less than ACE inhibitors.

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Area of Science:

  • Cardiology
  • Pharmacology

Context:

  • Nitrates are commonly prescribed for heart failure.
  • Acute administration causes venous vasodilatation, reducing pulmonary and left ventricular end-diastolic pressures.
  • High doses also induce arterial vasodilator effects.

Purpose:

  • To review the hemodynamic effects of nitrates in heart failure.
  • To discuss the phenomenon of hemodynamic escape during chronic administration.
  • To evaluate the impact of nitrates on exercise capacity and mortality.

Summary:

  • Chronic nitrate administration leads to hemodynamic escape, diminishing peripheral vasodilator effects.
  • Combination therapy with isosorbide dinitrate-hydralazine improved exercise capacity and survival in heart failure trials.
  • Nitrates may be considered for symptom improvement in patients with persistent dyspnea on ACE inhibitors, with careful blood pressure monitoring.

Impact:

  • The combination of nitrates and hydralazine offers a viable alternative when ACE inhibitors are contraindicated.
  • Nitrates can help manage persistent dyspnea in heart failure patients already on ACE inhibitors.
  • Understanding nitrate tolerance is crucial for optimizing heart failure management.

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