Nitroglycerine infarction

Nitroglycerin remains the dmg of choice for treatment of angina pectoris. It has also been found useful for the treatment of congestive heart failure, myocardial infarction, peripheral vascular disease, such as Raynaud s disease, and mitral insufficiency, although the benefits of nitroglycerin in mitral insufficiency have been questioned. 

Ms. Moore is admitted with severe chest pain and a possible myocardial infarction. After tests are done, her primary health care provider prescribes transdermal nitroglycerin for her angina. Develop a teaching plan that will show Ms. Moore how and when to apply the transdermal form of nitroglycerin. 

Vasopressin, alone or in combination with nitroglycerin, can no longer be recommended as first-line therapy for the management of variceal hemorrhage. Vasopressin causes nonselective vasoconstriction and can result in hypertension, severe headaches, coronary ischemia, myocardial infarction, and arrhythmias. 

Marchionni N, Schneeweiss A, Di Bari M, Ferrucci L, Moschi G, Salani B et al. Age-related hemodynamic effects of intravenous nitroglycerin for acnte myocardial infarction and left ventricular failure. Am J Cardiol... 

Nitroglycerin by sublingual tablet (0.4 mg) every 5 minutes for a total of 3 doses will be used for ischemic discomfort relief. Intravenous injection will be considered when the ischemic discomfort, hypertension or pulmonary congestion cannot be controlled. Nitrates should not be used when the blood pressure is lower than 90 mmHg or 30 mmHg lower than a known base line value, bradycardia less than 50 bpm, tachycardia more than 100 bpm or suspected right ventricular (RV) infarction. 

Nitric oxide released from nitroglycerin stimulates guanylyl cyclase in platelets as in smooth muscle. The increase in cGMP that results is responsible for a decrease in platelet aggregation. Unfortunately, recent prospective trials have established no survival benefit when nitroglycerin is used in acute myocardial infarction. 

MI usually develops after rupture or erosion of an atherosclerotic plaque within a coronary blood vessel. At this site, the clotting cascade is activated and the resultant thrombus occludes the lumen. In all patients under suspicion of MI, immediate therapy has to be initiated by the emergency physician. To relieve the patient from severe pain and anxiety, morphine and a benzodiazepine need to be given. Antiplatelet drugs and heparin are necessary for preventing further formation of thrombi. Nitroglycerin can be used to reduce cardiac load. When blood pressure and heart rate have stabilized, a p-blocker can be administered to lower cardiac 02 consumption and the risk of arrhythmias. Infusion of lidocaine is required to counter the threat of arrhythmias. The chance of survival of the MI patient depends on the interval between the onset of infarction and the start of therapy. 

Diodati J, Theroux P, Latour JG et d (1990) Effects of nitroglycerin at therapeutic doses on platdet aggregation in unstable angina pectoris and acute myocardial infarction. Am J Cardiol 66 683-688. 

RuDusky BM. Acute myocardial infarction secondary to coronary vasospasm during withdrawal from industrial nitroglycerin exposure—a case report. Angiology 2001 52(2) 143. ... 

M. Hill, H. Takano, X.-L. Tang, E. Kodani, G. Shirk, R. Bolli, Nitroglycerin induces late preconditioning against myocardial infarction in conscious rabbits despite development of nitrate tolerance, Circulation 104, 694-699 (2001). 

A patient with myocardial infarction is treated with nitroglycerin to dilate his coronary arteries. Which of the following best describes the action of nitroglycerin ... 

STE and NSTE ACS, class I indication in patients whose symptoms are not fully relieved with three sublingual nitroglycerin tablets and initiation of, 6-blocker therapy, in patients with large infarctions, those presenting with heart failure or those who are hypertensive on presentation... 

MIAMI Metoprolol In Acute Myocardial Infarction NRMI National Registry of Myocardial Infarction NTG nitroglycerin... 

CABG, coronary artery bypass MI, myocardial infarction CAD, coronary artery disease NTG, nitroglycerin CCS, Canadian cardiovascular study ECG, electrocardiogram. 

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