Why the study?
Does a daily nitrate-free interval reduce anginal events in patients with severe congestive heart failure secondary to myocardial ischemia on intravenous nitroglycerin?
Does a daily nitrate-free interval reduce anginal events in patients with severe congestive heart failure secondary to myocardial ischemia on intravenous nitroglycerin?
A daily nitrate-free interval of 4-7 hours is not supported for preventing ischemic events in hospitalized patients with severe heart failure and recurrent ischemia on intravenous nitroglycerin, as it may increase anginal events.
May increase anginal events in severe ischemic HF; hypothesis-generating case report that leaves optimal IV nitroglycerin strategy open.
A daily nitrate‐free interval (NFI) lasting 4–7 hours was instituted in four patients with severe congestive heart failure secondary to myocardial ischemia who were awaiting orthotopic heart transplantation. The duration of intravenous nitroglycerin therapy ranged from 14–55 days, and the maximum dosage was 50–400 μg/minute. Anginal events occurred more frequently during the NFI than during intravenous therapy. An NFI of 8–12 hours reduces tolerance in patients with congestive heart failure and stable angina. However, the experience in these patients with recurrent ischemia does not support its use to prevent ischemic events during hospitalization.
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Earl et al. (1998) studied this question.
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