Ineffectiveness of sublingual nitroglycerin in acute left ventricular failure in the presence of massive peripheral edema

Fabio Magrini, Andreas P. Niarchos

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Although it has been postulated that peripheral edema may reduce venous compliance in patients with congestive heart failure, this possibility has not yet been Investigated. Sublingual nitroglycerin, 1.6 to 2.4 mg, was administered to 15 patients with acute left ventricular failure, including 8 patients without peripheral edema (group I) and 7 patients with massive peripheral edema (group II). Baseline hemodynamic variables were similar in the two groups. In group I, sublingual nitroglycerin decreased the left ventricular filling pressure from 28 ± 2 (mean ± 1 standard deviation) to 14 ± 3 mm Hg (p <0.005), whereas cardiac output increased from 3.3 ± 0.4 to 4.3 ± 0.3 liters/min (p <0.005) because of an increase in stroke volume. Right atrial pressure decreased from 28 ± 3 to 13 ± 3 mm Hg (p <0.005). In group II, no significant hemodynamic changes were induced by nitroglycerin despite the elevated baseline left ventricular filling pressure of 30 ± 5 mm Hg and right atrial pressure of 29 ± 4 mm Hg. Five patients from group II were rechallenged with sublingual nitroglycerin 18 days after furosemide therapy, when the peripheral edema had cleared (6 kg weight loss). At this time there were significant decreases in left ventricular filling pressure (from 13 ± 2 to 9 ± 2 mm Hg; p <0.025) and right atrial pressure (from 13 ± 1 to 9 ± 2 mm Hg; p <0.005); cardiac output was not increased, probably because of the normal baseline left ventricular filling pressure. These results indicate that through various mechanisms massive peripheral edema decreases venous compliance and therefore prevents nitroglycerin from reducing preload.

Original languageEnglish
Pages (from-to)841-847
Number of pages7
JournalThe American Journal of Cardiology
Issue number4
Publication statusPublished - 1980

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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