Nitrat szarmazekok a szivelegtelenseg kezeleseben

Translated title of the contribution: The role of nitrates in the treatment of heart failure

I. Preda, J. Fiok

Research output: Contribution to journalArticle

Abstract

Nitrates are commonly used in the therapy of congestive heart failure. Although the use of these drugs has not been evaluated by randomized, multicentre studies, organic nitrates have been shown to have beneficial effect on myocardial ischemia, left ventricular filling pressure, magnitude of mitral regurgitation, endothelial function, and cardiac remodeling. Nitrates alone or in combination with hydralazine have improved exercise capacity, maximal oxygen consumption and survival. Nitrate therapy particularly decreases the pathologically elevated pulmonic venous pressure, therefore it is suitable for the treatment of pulmonary oedema. The acute use of nitrates causes decrease in left ventricular filling pressure, mitral regurgitation and increase in cardiac output. In this case the dose of intravenous nitroglycerin, starting with 0.25 μg/kg/min, can be increased in every 5 min to 2 μg/kg/min, and the effect of nitroglycerin is additive with the positive inotropic effect of dopamine or dobutamine. The use of nitrates in patients with chronic heart failure has been limited by reduced hemodynamic responsiveness (tolerance). In heart failure, the development of nitrate tolerance (reduced vascular response) results in the need to use a larger dose of nitrate. Nitrate tolerance is caused by increased levels of superoxide at the vascular wall, which leads to increased sensitivity to vasoconstrictive mechanisms, such as endothelin and angiotensin II. In the case of nitrate tolerance, intermittent dosing of nitrates, allowing a 12-hour nitrate-free interval is effective in preventing it. Recent information suggests that augmentation of nitrate dose and a concomitant use of hydralazine may prevent or decrease the significance of nitrate tolerance.

Original languageHungarian
Pages (from-to)4-9
Number of pages6
JournalOrvoskepzes
Volume72
Issue number1
Publication statusPublished - 1997

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Treatment Failure
Nitrates
Heart Failure
Hydralazine
Nitroglycerin
Mitral Valve Insufficiency
Ventricular Pressure
Blood Vessels
Venous Pressure
Dobutamine
Endothelins
Pulmonary Edema
Oxygen Consumption
Superoxides
Angiotensin II
Cardiac Output
Multicenter Studies
Myocardial Ischemia
Dopamine
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Nitrat szarmazekok a szivelegtelenseg kezeleseben. / Preda, I.; Fiok, J.

In: Orvoskepzes, Vol. 72, No. 1, 1997, p. 4-9.

Research output: Contribution to journalArticle

Preda, I & Fiok, J 1997, 'Nitrat szarmazekok a szivelegtelenseg kezeleseben', Orvoskepzes, vol. 72, no. 1, pp. 4-9.
Preda, I. ; Fiok, J. / Nitrat szarmazekok a szivelegtelenseg kezeleseben. In: Orvoskepzes. 1997 ; Vol. 72, No. 1. pp. 4-9.
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