Treatment of Refractory Heart Failure with Infusion of Nitroprusside

Abstract Sodium nitroprusside infused in 18 patients with intractable heart failure (nine with ischemic heart disease and nine with cardiomyopathy) produced a prompt reduction of left ventricular filling pressure (pulmonary wedge or left ventricular end-diastolic pressure) from an average of 32.2 to 17.2 mm Hg and a rise in cardiac output from an average of 2.98 to 5.2 liters per minute. Mean arterial pressure fell by 15 mm Hg, and heart rate was slightly but significantly slowed. Stroke volume and forward ejection fraction were nearly doubled. Responses were similar in ischemic heart disease and cardiomyopathy. A diuresis and natriuresis accompanied the infusion, and the clinical response was sustained in five patients in whom the drug was continued for 24 to 72 hours. These results suggest that intractable heart failure may be effectively treated by reduction in impedance to left ventricular ejection. (N Engl J Med 291:587–592, 1974)