The altered baroreceptor response to nitroglycerin in congestive heart failure
Why the study?
Does the heart rate response to sublingual nitroglycerin identify patients with elevated filling pressures who benefit from its vasodilator action in chronic cardiac disorders?
Population
33 patients with a variety of chronic cardiac disorders
Design
Cross-sectional
Authors
Discussion
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Member takes
Implication
May identify nitroglycerin responders with elevated filling pressures; hypothesis-generating and requires prospective validation before practice change.
Key Points
- To evaluate the mechanisms behind heart rate variability following nitroglycerin administration and determine how baroreceptor sensitivity relates to left ventricular dysfunction.
- Administered 0.4 mg of sublingual nitroglycerin to 33 patients with chronic cardiac disorders.
- Measured changes in heart rate, left ventricular end-diastolic pressure, and mean pulmonary artery pressure.
- A heart rate increase of less than 3 beats/min reliably identified patients with left ventricular end-diastolic pressure >18 mmHg or pulmonary artery mean pressure >22 mmHg.
- Patients exhibiting this blunted baroreceptor response showed substantial improvement in hemodynamic parameters following nitroglycerin administration.
Structured PICO
Does the heart rate response to sublingual nitroglycerin identify patients with elevated filling pressures who benefit from its vasodilator action in chronic cardiac disorders?
P
Population
33 patients with a variety of chronic cardiac disorders
I
Intervention
Nitroglycerin 0.4 mg sublingually
O
Outcome
Heart rate response and its relationship to left ventricular end-diastolic pressure, pulmonary artery mean pressure, and hemodynamic improvementsurrogate
A blunted heart rate response (<3 beats/min) to sublingual nitroglycerin can serve as a simple bedside marker to identify patients with elevated left ventricular filling pressures who will benefit hemodynamically from the drug.
Cite This Study
Faxon et al. (1980) studied this question.