Clinical Study
Effect of sublingually administered nitroglycerin on regional myocardial blood flow in patients with coronary artery disease*

https://doi.org/10.1016/S0002-9149(77)80127-6Get rights and content

The effect of sublingually administered nitroglycerin on regional myocardial specific blood flow (in ml/min per 100 g tissue) was evaluated with a xenon-133 washout technique in 31 patients in a resting nonstressed state. Eight patients had normal coronary arteriograms (Group 1), 12 had coronary artery disease without collateral vessels (Group 2) and 11 had coronary artery disease with collateral vessels (Group 3). Although nitroglycerin caused a similar decrease in mean arterial blood pressure and blood pressure-heart rate product in all three groups, the decrease in regional myocardial blood flow was significantly less in Group 3 (−8 ± 6 percent [mean ± standard error of the mean]) than in Group 1 (−31 ± 5 percent, P < 0.05); an intermediary decrease occurred in Group 2 (−23 ± 5 percent). Within Group 3, there was a mean increase in regional myocardial blood flow after nitroglycerin in the five patients whose collateral vessels were of a higher angiographic grade and arose from non-stenosed coronary arteries, whereas a reduction was observed in the six patients with none or only one of these findings (+10 ± 7 percent versus −23 ± 3 percent, P < 0.001). This study suggests that even in the resting state, in some patients with coronary artery disease enhancement of regional myocardial blood flow can occur after sublingual administration of nitroglycerin and is probably mediated through well functioning collateral vessels. It is possible that the drug's effects on both the coronary and systemic circulation may relieve angina in some patients with coronary artery disease.

References (31)

  • GanzW et al.

    Failure of intracoronary nitroglycerin to alleviate pacing-induced angina

    Circulation

    (1972)
  • KnoebelSB et al.

    Myocardial blood flow in coronary artery disease. Effect of right atrial pacing and nitroglycerin

    Circulation

    (1973)
  • HermanMV et al.

    Localized disorders in myocardial contraction. Asynergy and its role in congestive heart failure

    N Engl J Med

    (1967)
  • GoldsteinRE et al.

    Intraoperative coronary collateral function in patients with coronary occlusive disease. Nitroglycerin responsiveness and angiographic correlations

    Circulation

    (1974)
  • HolmanBL et al.

    Measuring regional myocardial blood flow with 133Xe and the Anger camera

    Radiology

    (1974)
  • Cited by (71)

    • Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure

      2017, American Journal of Emergency Medicine
      Citation Excerpt :

      In fact, 2 patients in the bolus group had initial blood pressures of 84/55 and 96/69 received 1 and 2 mg of bolus nitroglycerin with no adverse events. This was potentially a concern with the use of high doses of nitroglycerin given that previous evidence indicated a decrease in myocardial blood flow in patients with coronary heart disease given sublingual nitroglycerin [13] Combined with prior literature [10,12], our results suggest that bolus nitroglycerin can be safely used alone or in combination with standard continuous infusion of IV nitroglycerin in patients with AHF. This study has several limitations.

    • Transthoracic echocardiographic measurement of coronary blood flow and reserve

      1997, Journal of the American Society of Echocardiography
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    *

    This study was supported by Grants HL 11306, HL 7049, HL 11668 and GM0 18674 from the U.S. Public Health Service, Bethesda, Maryland.

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