Skip to main content
SpringerLink
Log in

Nitroprusside in decompensated heart failure: What should a clinician really know?

  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Sodium nitroprusside is an older intravenous vasodilator appropriate for acute hospital treatment of patients with congestive heart failure. It is a balanced arterial and venous vasodilator with a very short half-life, facilitating rapid titration. In general, it improves hemodynamic and clinical status by reducing systemic vascular resistance, left ventricular filling pressure, and increasing cardiac output. This review summarizes recently published literature and recent data regarding the use of this intravenous vasodilator in decompensated heart failure patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Miller RR, Vismara LA, DeMaria AN, et al.: Afterload reduction therapy with nitroprusside in severe aortic regurgitation: improved cardiac performance and reduced regurgitant volume. Am J Cardiol 1976, 38:564–567.

    Article  PubMed  CAS  Google Scholar 

  2. Mookherjee S, Keighley JF, Warner RA, et al.: Hemodynamic, ventilatory and blood gas changes during infusion of sodium nitroferricyanide (nitroprusside). Studies in patients with congestive heart failure. Chest 1977, 72:273–278.

    Article  PubMed  CAS  Google Scholar 

  3. Franciosa JA, Silverstein SR: Hemodynamic effects of nitroprusside and furosemide in left ventricular failure. Clin Pharmacol Ther 1982, 32:62–69.

    PubMed  CAS  Google Scholar 

  4. Yin FC, Guzman PA, Brin KP, et al.: Effect of nitroprusside on hydraulic vascular loads on the right and left ventricle of patients with heart failure. Circulation 1983, 67:1330–1339.

    PubMed  CAS  Google Scholar 

  5. Stevenson LW, Tillisch JH: Maintenance of cardiac output with normal filling pressures in patients with dilated heart failure. Circulation 1974, 6:1303–1308.

    Google Scholar 

  6. Stevenson LW, Bellil D, Grover-McKay M, et al.: Effects of afterload reduction (diuretics and vasodilators) on left ventricular volume and mitral regurgitation in severe congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 1987, 60:654–658.

    Article  PubMed  CAS  Google Scholar 

  7. Stevenson LW, Tillisch JH, Hamilton M, et al.: Importance of hemodynamic response to therapy in predicting survival with ejection fraction less than or equal to 20% secondary to ischemic or nonischemic dilated cardiomyopathy. Am J Cardiol 1990, 66:1348–1354.

    Article  PubMed  CAS  Google Scholar 

  8. Hamilton MA, Stevenson LW, Child JS, et al.: Acute reduction of atrial overload during vasodilator and diuretic therapy in advanced congestive heart failure. Am J Cardiol 1990, 65:1209–1212.

    Article  PubMed  CAS  Google Scholar 

  9. Masuyama T, Goar FG, Alderman EL, et al.: Effects of nitroprusside on transmitral flow velocity patterns in extreme heart failure: a combined hemodynamic and Doppler echocardiographic study of varying loading conditions. J Am Coll Cardiol 1990, 16:1175–1185.

    PubMed  CAS  Google Scholar 

  10. Coddens J, Delooft T, Vandenbroucke G: Effects of dobutamine and/or nitroprusside on the pulmonary circulation in patients with pulmonary hypertension secondary to end-stage heart failure. J Cardiothorac Vasc Anesth 1993, 7:321–325.

    Article  PubMed  CAS  Google Scholar 

  11. Capomolla S, Pozzoli M, Opasich C, et al.: Dobutamine and nitroprusside infusion in patients with severe congestive heart failure: hemodynamic improvement by discordant effects on mitral regurgitation, left atrial function, and ventricular function. Am Heart J 1997, 134:1089–1098.

    Article  PubMed  CAS  Google Scholar 

  12. Martins S, Soares RM, Do Rosario L, et al.: Early and medium term results of tailored therapy for heart failure. Rev Port Cardiol 2001, 20:261–282.

    PubMed  CAS  Google Scholar 

  13. Capomolla S, Febo O, Opasich C, et al.: Chronic infusion of dobutamine and nitroprusside in patients with end-stage heart failure awaiting heart transplantation: safety and clinical outcome. Eur J Heart Fail 2001, 3:601–610.

    Article  PubMed  CAS  Google Scholar 

  14. Johnson W, Omland T, Hall C, et al.: Neurohormonal activation rapidly decreases after intravenous therapy with diuretics and vasodilators for class IV heart failure. J Am Coll Cardiol 2002, 39:1623–1629.

    Article  PubMed  CAS  Google Scholar 

  15. Khot UN, Novaro GM, Popovic ZB, et al.: Treatment: vasodilatation with nitroprusside in symptomatic patients with severe aortic stenosis and congestive heart failure improves cardiac index. N Engl J Med 2003, 348:1756–1763.

    Article  PubMed  CAS  Google Scholar 

  16. Cioffi G, Stefenelli C, Tarantini L, et al.: Hemodynamic response to intensive unloading therapy (furosemide and nitroprusside) in patients > 70 years of age with left ventricular systolic dysfunction and decompensated chronic heart failure. Am J Cardiol 2003, 92:1050–1056.

    Article  PubMed  CAS  Google Scholar 

  17. Cioffi G, Tarantini L, Stefenelli C, et al.: Changes in plasma N-terminal proBNP levels and ventricular filling pressures during intensive unloading therapy in elderly with decompensated congestive heart failure and preserved left ventricular systolic function. J Cardiac Fail 2006, 12:608–615.

    Article  CAS  Google Scholar 

  18. Olson TP, Frantz RP, Snyder EM, et al.: Effects of acute changes in pulmonary wedge pressure on periodic breathing at rest in heart failure patients. Am Heart J 2007, 153:104. e1–104.e7.

    Google Scholar 

  19. Cioffi G, Tarantini L, Pulignano G, et al.: Prevalence, predictors and prognostic value of acute impairment in renal function during intensive unloading therapy in a community population hospitalized for decompensated heart failure. J Cardiovasc Med 2007, 8:419–427.

    Google Scholar 

  20. Mullens W, Abrahams Z, Francis GS, et al.: Sodium nitroprusside for advanced low-output heart failure. J Am Coll Cardiol 2008, 52:200–207.

    Article  PubMed  CAS  Google Scholar 

  21. Hollenberg SM: Vasodilators in acute heart failure. Heart Fail Rev 2007, 12:143–147.

    Article  PubMed  CAS  Google Scholar 

  22. Elkayam U, Janmohamed M, Habib M, et al.: Vasodilators in the management of acute heart failure. Crit Care Med 2008, 36:S95–S105.

    Article  PubMed  CAS  Google Scholar 

  23. Clyde WY: Vasodilator therapy for decompensated heart failure. J Am Coll Cardiol 2008, 52:208–210.

    Article  CAS  Google Scholar 

  24. Drugs.com: Nitroprusside (systemic). Accessible at http://www.drugs.com/ppa/nitroprusside-sodium.html. Accessed March 2009.

  25. Moazemi K, Chana JS, Willard AM, et al.: Intravenous vasodilator therapy in congestive heart failure. Drugs Aging 2003, 20:485–508.

    Article  PubMed  CAS  Google Scholar 

  26. Cohn JN, Burke LP: Nitroprusside. Ann Intern Med 1979, 91:752–757.

    PubMed  CAS  Google Scholar 

  27. Lavine SJ, Campbell CA, Held AC, et al.: Effect of inotropic and vasodilator therapy on left ventricular diastolic filling in dogs with severe left ventricular dysfunction. J Am Coll Cardiol 1990, 15:1165–1172.

    Article  PubMed  CAS  Google Scholar 

  28. Leier CV, Bambach D, Thompson MJ, et al.: Central and regional hemodynamic effects of intravenous isosorbide dinitrate, nitroglycerin and nitroprusside in patients with congestive heart failure. Am J Cardiol 1981, 48:1115–1123.

    Article  PubMed  CAS  Google Scholar 

  29. Olivari MT, Levine TB, Cohn JN: Abnormal neurohumoral response to nitroprusside infusion in congestive heart failure. J Am Coll Cardiol 1983, 2:411–417.

    PubMed  CAS  Google Scholar 

  30. Pozzoli M, Capomolla S, Pinna G, et al.: Doppler echocardiography reliably predicts pulmonary artery wedge pressure in patients with chronic heart failure with and without mitral regurgitation. J Am Coll Cardiol 1996, 27:883–893.

    Article  PubMed  CAS  Google Scholar 

  31. Capomolla S, Febo O, Caporotondi A, et al.: Non-invasive estimation of right atrial pressure by combined Doppler echocardiographic measurements of the inferior vena cava in patients with congestive heart failure. Ital Heart J 2000, 1:684–690.

    PubMed  CAS  Google Scholar 

  32. Gheorghiade M, Zannad F, Sopko G, et al.: Acute heart failure syndromes: current state and frame-work for future research. Circulation 2005, 112:3958–3968.

    Article  PubMed  Google Scholar 

  33. Gheorghiade M, Abraham W, Albert N, et al.: Systolic blood pressure at admission, clinical characteristics and outcomes in patients hospitalized with acute heart failure. JAMA 2006, 296:2217–2226.

    Article  PubMed  CAS  Google Scholar 

  34. Adams KF Jr, Fonarow GC, Emerman CL, et al.: Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 2005, 149:209–216.

    Article  PubMed  Google Scholar 

  35. Heart Failure Society of America: Executive summary: HFSA 2006 comprehensive heart failure practice guidelines. J Card Fail 2006, 12:10–38.

  36. Abraham WT, Adams KF, Fonarow GC, et al.: In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). J Am Coll Cardiol 2005, 46:57–64.

    Article  PubMed  Google Scholar 

  37. Stevenson LW: Tailored therapy before transplantation for treatment of advanced heart failure: effective use of vasodilators and diuretics. J Heart Lung Transplant 1991, 10:468–476.

    PubMed  CAS  Google Scholar 

  38. Popovic ZB, Khot UN, Novaro GM, et al.: Effects of sodium nitroprusside in aortic stenosis associated with severe heart failure: pressure-volume loop analysis using a numerical model. Am J Physiol Heart Circ Physiol 2005, 288:H416–H423.

    Article  PubMed  CAS  Google Scholar 

  39. Butler J, Forman DE, Abraham WT, et al.: Relationship between heart failure treatment and development of worsening renal function among hospitalized patients. Am Heart J 2004, 147:331–338.

    Article  PubMed  Google Scholar 

  40. Stevenson LW, Massie BM, Francis GS: Optimizing therapy for complex or refractory heart failure: a management algorithm. Am Heart J 1998, 135:S293–S309.

    Article  PubMed  CAS  Google Scholar 

  41. Carrol JD, Lang RM, Neumann AL, et al.: The differential effects of positive inotropic and vasodilator therapy on diastolic properties in patients with congestive cardiomyopathy. Circulation 1986, 74:815–825.

    Google Scholar 

  42. Berkowitz C, Mckeever L, Croke RP, et al.: Comparative responses to dobutamine and nitroprusside in patients with chronic low output cardiac failure. Circulation 1977, 56:918–924.

    PubMed  CAS  Google Scholar 

  43. Costanzo MR, Johannes RS, Pine M, et al.: The safety of intravenous diuretics alone versus diuretics plus parenteral vasoactive therapies in hospitalized patients with acutely decompensated heart failure: a propensity score and instrumental variable analysis using the Acutely Decompensated Heart Failure National Registry (ADHERE) database. Am Heart J 2007, 154:267–277.

    Article  PubMed  CAS  Google Scholar 

  44. Gallagher KL, Jones JK: Furosemide-induced ototoxicity. Ann Intern Med 1979, 91:744–745.

    PubMed  CAS  Google Scholar 

  45. Silverberg D, Wexler D, Blum M, et al.: The association between congestive heart failure and chronic renal disease. Curr Opin Nephrol Hypertens 2004, 13:163–170.

    Article  PubMed  CAS  Google Scholar 

  46. Wienfeld MS, Chertow GM, Stevenson LW: Aggravated renal dysfunction during intensive therapy for advanced chronic heart failure. Am Heart J 1999, 138:285–290.

    Article  Google Scholar 

  47. Bart BA, Goldsmith SR: Aggravated renal dysfunction and the acute management of advanced chronic heart disease. Am Heart J 1999, 138:200–202.

    Article  PubMed  CAS  Google Scholar 

  48. Shlipak MG, Massie BM: The clinical challenge of cardiorenal syndrome. Circulation 2004, 110:1514–1517.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Salvatore Maugeri Foundation, Via Salvatore Maugeri, N.10-27100, Pavia, Italy

    Cristina Opasich

Authors
  1. Cristina Opasich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni Cioffi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessandra Gualco
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cristina Opasich.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Opasich, C., Cioffi, G. & Gualco, A. Nitroprusside in decompensated heart failure: What should a clinician really know?. Curr Heart Fail Rep 6, 182–190 (2009). https://doi.org/10.1007/s11897-009-0026-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11897-009-0026-4

Keywords

Search

Navigation