Elsevier

The Lancet

Volume 321, Issue 8327, 2 April 1983, Pages 730-733
The Lancet

HAEMODYNAMIC ADVANTAGES OF ISOSORBIDE DINITRATE OVER FRUSEMIDE IN ACUTE HEART-FAILURE FOLLOWING MYOCARDIAL INFARCTION

https://doi.org/10.1016/S0140-6736(83)92025-1Get rights and content

Abstract

The immediate haemodynamic effects of intravenous frusemide (1 mg/kg) and intravenous isosorbide dinitrate (50-200 μg/kg/h) were compared in a prospective, randomised, between-group study in 28 men with radiographic and haemodynamic evidence of left ventricular failure following acute myocardial infarction. The diuresis induced by frusemide reduced the left heart filling pressure and cardiac output and transiently raised systemic blood-pressure. In contrast, isosorbide dinitrate was accompanied by a reduction in systemic blood-pressure and peripheral resistance with the result that the cardiac output was not decreased despite a large fall in the pulmonary vascular and left heart filling pressures. These results indicate that reduction of excessive preload by venodilatation may be haemodynamically superior to that induced by diuresis in terms of both reducing myocardial oxygen consumption and maintaining peripheral perfusion. The influence of these contrasting treatments on the prognosis of these high-risk patients warrants further study.

References (30)

  • Js Forrester et al.

    Medical therapy of acute myocardial infarction by application of haemodynamic subsets

    N Engl J Med

    (1976)
  • Pr Maroko et al.

    Factors influencing infarct size following coronary artery occlusions

    Circulation

    (1973)
  • Dt Kelly et al.

    Use of phentolamine in acute myocardial infarction associated with hypertension and left ventricular failure

    Circulation

    (1973)
  • We Shell et al.

    Protection of jeopardised ischaemic myocardium by reduction of ventricular afterload

    N Engl J Med

    (1974)
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