Effects of Nitroglycerin on “Maximal’ Oxygen Intake and Exercise Electrocardiogram in Coronary Heart Disease

Oxygen intake (VO2) was measured during the last few minutes of a multistage treadmill test of maximal exercise in 12 healthy middle-aged persons, 32 patients with angina, and 23 survivors of myocardial infarction free of angina. Repetition of the same test, after each individual rested 30 min and took 0.4 mg nitroglycerin sublingually, increased VO2 max in patients with angina (by 14.5%, P < 0.001) and in patients with prior infarction (by 6%, P < 0.005) but not in healthy persons. Angina at VO2 max was prevented in 12 patients. Maximal heart rate was increased by 11% in the angina group and by 4% in the myocardial infarction group; the maximal blood pressure-heart rate product was increased (P < 0.005) only in patients with angina. [See Equation in PDF file] voltages from 50 to 69 msec after the nadir of S wave (S-TB) were quantified by computer averaging of 100 beat samples at several intervals during and after exercise. The amount of [See Equation in PDF file] depression during and after exercise was significantly reduced after administration of nitroglycerin in all three groups.We conclude that nitroglycerin: (1) increases maximal circulatory conductance of O2 in patients with coronary heart disease, whether or not limited by angina, mainly by increased maximal heart rate, and (2) lessens evidence of electrocardiographic myocardial ischemia and lowers frequency if angina pectoris despite the same or a higher pressure-rate index. These effects suggest a reduction in peripheral vascular tone and left ventricular end-diastolic pressure and volume with nitroglycerin.

[1]  L. Brasseur,et al.  Hemodynamic Determinants of Exercise ST‐Segment Depression in Coronary Patients , 1970, Circulation.

[2]  P. Armstrong,et al.  The Influence of Changes in Blood Volume on Angina Pectoris: A Study of the Effect of Phlebotomy , 1970, Circulation.

[3]  R. Bruce,et al.  Comparative Effects of Aging and Coronary Heart Disease on Submaximal and Maximal Exercise , 1969, Circulation.

[4]  S. Epstein,et al.  Hemodynamic Accompaniments of Angina: A Comparison During Angina Induced by Exercise and by Atrial Pacing , 1969, Circulation.

[5]  J. Parker,et al.  Reversible Cardiac Failure During Angina Pectoris: Hemodynamic Effects of Atrial Pacing in Coronary Artery Disease , 1969, Circulation.

[6]  J. W. Cox,et al.  Hemodynamic Effects of Nitroglycerin, Propranolol, and Their Combination in Coronary Heart Disease , 1969, Circulation.

[7]  E. Sowton,et al.  Haemodynamic comparisons of atrial pacing and exercise in patients with angina pectoris. , 1969, British heart journal.

[8]  H. Westling,et al.  Haemodynamic effects of nitroglycerin in normal subjects during supine and sitting exercise. , 1969, British heart journal.

[9]  L. Rowell,et al.  Disparities Between Aortic and Peripheral Pulse Pressures Induced by Upright Exercise and Vasomotor Changes in Man , 1968, Circulation.

[10]  B. Robinson.  Mode of action of nitrglycerin in angina pectoris. Correlation between haemodynamic effects during exercise and prevention of pain. , 1968, British heart journal.

[11]  J. Parker,et al.  The Hemodynamic Response to Exercise in Patients With Healed Myocardial Infarction Without Angina: With Observations on the Effects of Nitroglycerin , 1967, Circulation.

[12]  H. Russek.  PROPRANOLOL AND ISOSORBIDE DINITRATE SYNERGISM IN ANGINA PECTORIS , 1967, The American journal of the medical sciences.

[13]  B. Robinson,et al.  Relation of Heart Rate and Systolic Blood Pressure to the Onset of Pain in Angina Pectoris , 1967, Circulation.

[14]  H Roskamm,et al.  Optimum patterns of exercise for healthy adults. , 1967, Canadian Medical Association journal.

[15]  G. Grimby,et al.  Repeated serial determination of cardiac output during 30 min exercise. , 1966, Journal of applied physiology.

[16]  J. Parker,et al.  A hemodynamic study of acute coronary insufficiency precipitated by exercise. With observations on the effects of nitroglycerin. , 1966, The American journal of cardiology.

[17]  R A Bruce,et al.  Quantitation of QRS and ST segment responses to exercise. , 1966, American heart journal.

[18]  E. Braunwald,et al.  The Effects of Nitroglycerin and Amyl Nitrite on Arteriolar and Venous Tone in the Human Forearm , 1965, Circulation.

[19]  R. Macalpin,et al.  The Effect of a &bgr;‐Adrenergic‐Blocking Agent (Nethalide) and Nitroglycerin on Exercise Tolerance in Angina Pectoris , 1965, Circulation.

[20]  E. Rolett,et al.  Hemodynamic Studies during Angina Pectoris , 1965, Circulation.

[21]  E. Braunwald,et al.  Studies on Cardiac Dimensions in Intact, Unanesthetized Man: IV. Effects of Isoproterenol and Methoxamine , 1964, Circulation.

[22]  D. Kinsella,et al.  Studies with a new coronary vasodilator drug: persantin. , 1962, American heart journal.

[23]  E. Braunwald,et al.  Hemodynamic determinants of oxygen consumption of the heart with special reference to the tension-time index. , 1957, The American journal of physiology.

[24]  H. Russek.  Propranolol and isosorbide dinitrate synergism in angina pectoris. , 1968, The American journal of cardiology.

[25]  R. Bruce,et al.  MYOCARDIAL ISCHEMIA AFTER MAXIMAL EXERCISE IN HEALTHY MEN. A METHOD FOR DETECTING POTENTIAL CORONARY HEART DISEASE? , 1965, American heart journal.

[26]  R. Malmborg.  A CLINICAL AND HEMODYNAMIC ANALYSIS OF FACTORS LIMITING THE CARDIAC PERFORMANCE IN PATIENTS WITH CORONARY HEART DISEASE. , 1965, Acta medica Scandinavica. Supplementum.

[27]  Malmborg Ro.  A CLINICAL AND HEMODYNAMIC ANALYSIS OF FACTORS LIMITING THE CARDIAC PERFORMANCE IN PATIENTS WITH CORONARY HEART DISEASE. , 1965 .