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By Dr. Adam Schneeweiss, Dr. Marija Weiss (auth.)

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ISDN produces these effects and, in addition also reduces the systemic vascular resistance. ) published over 10 years ago a series of reports on the hemodynamic effects of various nitrate formulations in acute myocardial infarction. 6 mg, significantly lowered the left ventricular f:tlling pressure and pulmonary arterial pressures within 3-5 min after administration. In six of the patients who had acute pulmonary edema the dyspnea was relieved within a few minutes after administration of nitroglycerin sublingually.

There are, however, three problems with this approach: 1. It is not known whether beta-blockers exert their protective effects for periods longer than those studied in the secondary prevention trials. 2. About one-third of the patients, or even more, can not receive beta-blockers for this indication. 3. In patients with transient heart failure during acute myocardial infarction beta-blockers may provoke recurrences of heart failure late after the acute event. In patients with Raynaud's phenomenon or intermittent claudications betablockers should not be used.

They found a significant decrease in infarct size and in the frequency of early sudden death in patients treated with nitroglycerin. These investigators attributed the beneficial effect to early treatment of left ventricular failure. The leaders in the use of nitrates in acute myocardial infarction are Bussmann and coworkers from Frankfurt/M. [141]. They measured infarct size by the enzyme CK and the isoenzyme CK-MB in 60 patients, half of them treated with nitroglycerin intravenously. Infarct size was reduced by 30% in the treated group compared with the control group.

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