Feasibility of Nitroprusside Therapy in Patients with Hypotension Due to Severe Left Ventricular Failure in Acute Myocardial Infarction

Abstract

The beneficial effect of sodium nitroprusside (NPN) therapy in patients with acute myocardial infarction and severe left ventricular failure due to a reduction of preload and afterload is generally accepted. However, there are doubts about the indication of vasodilator therapy in patients who already have low systemic pressure, since a further reduction in aortic pressure may not be tolerated and may critically lower coronary perfusion pressure. Sympathomimetic drugs are no easy solution to this problem [4] as they enhance oxygen consumption and thus, after an initial improvement, may lead to final deterioration due to extension of necrosis. On the other hand, by careful titration of NPN-dosage it may be possible to lower the peripheral resistance to the level at which it can be compensated for by an increase in cardiac output (CO) and thus prevent a significant fall in systemic pressure. This was the goal in the following investigation involving 14 patients.