Current Heart Failure Reports

, Volume 12, Issue 1, pp 87–93 | Cite as

Impact of Intravenous Nitroglycerin in the Management of Acute Decompensated Heart Failure

  • Corstiaan A. den UilEmail author
  • Jasper J. Brugts
Management of Heart Failure (TE Meyer, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Management of Heart Failure


Intravenous nitroglycerin is a well-known, but underused, treatment for acute decompensated heart failure. Nitroglycerin has a rapid onset of action and short half-life and there is a clear dose-response curve on both global hemodynamics and peripheral circulation. IV nitroglycerin reduces LV and RV filling pressures and afterload. In the case of acute decompensated heart failure, there is a typical decreased bioavailability of nitric oxide (NO), which needs to be supplemented by exogenous nitrates. Additionally, there is benefit on clinical endpoints, such as fast optimization of arterial oxygenation, lower rates of mechanical ventilation, and improved survival. Drawbacks of therapy include not only side effects such as headache, resistance, and development of tolerability to nitrates but also free radical production. However, nitrates in combination with diuretics remain the cornerstone of acute decompensated heart failure treatment. We propose a more aggressive use of nitrates and a more limited use of inotropes (due to ischemic demand and pro-arrhythmogenic characteristics) in normo- or hypertensive patients with acute heart failure.


Acute heart failure Critical care Emergency care Hemodynamics Inodilators Intensive care Microcirculation Nitrates Nitroglycerin Perfusion Vasodilators 


Compliance with Ethics Guidelines

Conflict of Interest

Corstiaan A. den Uil and Jasper J. Brugts declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of CardiologyErasmus Medical Center, ThoraxcenterCE RotterdamThe Netherlands

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