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Systemic and coronary hemodynamic effects of combined intravenous diltiazem and nitroglycerin administration


American Heart Journal 113(6): 1376-1382
Systemic and coronary hemodynamic effects of combined intravenous diltiazem and nitroglycerin administration
This study evaluated left ventricular (LV) and coronary hemodynamic effects of intravenous nitroglycerin (NTG) in the presence of an intravenous infusion of diltiazem in 15 patients with severe coronary disease. Diltiazem (250 .mu.g/kg bolus followed by 1.4 .mu.g/kg/min infusion) alone decreased mean systemic blood pressure (mean 6%) without changing heart rate or LV end-diastolic pressure. The rate of rise in LV pressure declined slightly (4%), and peripheral resistance decreased (19%). Coronary sinus (CS) and great cardiac vein (GCV) flows were preserved. Addition of NTG (average, 68 .mu.g/min) decreased systemic pressure further (7%) as LV end-diastolic pressure declined (5 mm Hg). These pressure changes were accompanied by a 10% increase in heart rate (compared with the heart rate found with diltiazem alone). Peripheral resistance was similar to values after diltiazem alone. The CS and GCV flows did not decrease. The sequence of intravenous drug administration was reversed in three patients with combination therapy, producing similar effects, regardless of which drug was administered first. Hemodynamic effects of intravenous diltiazem alone and its combination with intravenous NTG seemed potentially favorable for patients with ischemic heart disease.

Accession: 006574933

PMID: 3109225

DOI: 10.1016/0002-8703(87)90651-x

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