Effect of combined nitroglycerin and dobutamine infusion in left ventricular dysfunction

• Published in: The American heart journal Vol. 106; no. 1; pp. 35 - 40
• Main Authors: Awan, Najam A., Evenson, Mark K., Needham, Kathleen E., Beattie, James M., Mason, Dean T.
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.07.1983
• Subjects: Catecholamines - therapeutic use; Dobutamine - therapeutic use; Drug Therapy, Combination; Female; Heart Failure - drug therapy; Heart Failure - etiology; Heart Ventricles - drug effects; Hemodynamics - drug effects; Humans; Male; Middle Aged; Myocardial Infarction - complications; Nitroglycerin - therapeutic use
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/0002-8703(83)90435-0

The immediate therapy of severe left ventricular (LV) failure after acute myocardial infarction (AMI) frequently requires simultaneous preload reduction, pump output augmentation, and maintenance of systemic blood pressure. Therefore the effects of intravenous nitroglycerin (NG) and dobutamine (DB) were evaluated in 12 patients with severe LV failure following AMI. Nitroglycerin achieved salutary lowering of abnormally elevated LV filling pressure (23 to 14 mm Hg, p < 0.001) while DB markedly augmented LV pump function (cardiac index rose from 1.7 to 2.5 L/min/m 2, p < 0.005). Notably, the combined infusion of NG + DB simultaneously decreased preload (LV filling pressure 23 to 14 mm Hg, p < 0.001) and markedly enhanced LV pump performance (cardiac index increased from 1.7 to 2.4 L/min/m 2, p < 0.001). Minor decline in mean systemic blood pressure with NG (72 to 66 mm Hg, p < 0.05) was rapidly reversed by DB addition (69 mm Hg, p > 0.05). Both agents were well tolerated without clinical or ECG evidence of myocardial ischemia or dysrhythmias. Thus the principally venodilator effects of NG minimize systemic hypotension while salutary augmentation of cardiac function in AMI with LV failure is achieved by NG + DB.