Skip to main content
NCBI home page
Journal of the National Medical Association logoLink to Journal of the National Medical Association
letter
. 1980 Nov;72(11):1045–1056.

Reduction of Myocardial Ischemic Injury with Sublingual Isosorbide Dinitrate

Sadayappa K Durairaj, Kalayanasundaram Venkataraman, L Julian Haywood
PMCID: PMC2552596  PMID: 7441784

Abstract

Twenty-one patients with acute anterior myocardial infarction had precordial ST segment mapping, using a system of 42 leads, at 0, 2, 4, 8, 24, and 48 hours (control group). Eleven patients (treatment group) had maps on admission and after 30-45 minutes; then serial maps were performed at similar intervals after 5-10 mg of isosorbide dinitrate (ISD). There were no significant differences in age, sex, functional class, mean time elapsed between onset of chest pain and admission, and inhospital mortality between the groups. Controls had a higher incidence of recurrent MI (6 patients vs 2) compared with the ISD group (P less than 0.05).

The sum of ST segment elevations in all leads (ΣST) was similar in both groups on admission and remained at the same level in controls for 48 hours. One hour after ISD the blood pressure decreased significantly; ΣST and the number of leads with more than 1 mm ST elevation (NST) decreased significantly (62±10 to 31±4 / 26±1 to 19±2) (P less than 0.01). In the ISD group serial ST maps showed significant decreases (52±5 vs 28±4; 44±4 vs 26±2; 45±4 vs 29±3; 51±5 vs 28±3, 52±8 vs 28±2, respectively at 2, 4, 8, 24 and 48 hours), suggesting reduction of ischemic injury by ISD.

Estimation of infarct size (in units from R wave height and Q and S wave depths in leads I, AVL and V1-V6) indicated a reduction in the ISD group on days one, two and seven. Total CPK, SGOT and LDH levels were similar on admission; at 24 and 48 hours after admission CPK values were not significantly different but SGOT and LDH were lower in the treated group.

Full text

PDF
1045

Images in this article

1054Figure 6
on p.1054

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Awan N. A., Amsterdam E. A., Vera Z., DeMaria A. N., Miller R. R., Mason D. T. Reduction of ischemic injury by sublingual nitroglycerin in patients with acute myocardial infarction. Circulation. 1976 Nov;54(5):761–765. doi: 10.1161/01.cir.54.5.761. [DOI] [PubMed] [Google Scholar]
  2. Borer J. S., Redwood D. R., Levitt B., Cagin N., Bianchi C., Vallin H., Epstein S. E. Reduction in myocardial ischemia with nitroglycerin or nitroglycerin plus phenylephrine administered during acute myocardial infarction. N Engl J Med. 1975 Nov 13;293(20):1008–1012. doi: 10.1056/NEJM197511132932002. [DOI] [PubMed] [Google Scholar]
  3. Braunwald E. Control of myocardial oxygen consumption: physiologic and clinical considerations. Am J Cardiol. 1971 Apr;27(4):416–432. doi: 10.1016/0002-9149(71)90439-5. [DOI] [PubMed] [Google Scholar]
  4. Braunwald E., Maroko P. R. ST-segment mapping. Realistic and unrealistic expectations. Circulation. 1976 Oct;54(4):529–532. doi: 10.1161/01.cir.54.4.529. [DOI] [PubMed] [Google Scholar]
  5. Bussmann W. D., Löhner J., Kaltenbach M. Orally administered isosorbide dinitrate in patients with and without left ventricular failure due to acute myocardial infarction. Am J Cardiol. 1977 Jan;39(1):91–96. doi: 10.1016/s0002-9149(77)80017-9. [DOI] [PubMed] [Google Scholar]
  6. Capone R. J., Most A. S., Sydik P. A. Precordial ST segment mapping. A sensitive technique for the evaluation of myocardial injury? Chest. 1975 May;67(5):577–582. doi: 10.1378/chest.67.5.577. [DOI] [PubMed] [Google Scholar]
  7. Chatterjee K., Parmley W. W., Ganz W., Forrester J., Walinsky P., Crexells C., Swan H. J. Hemodynamic and metabolic responses to vasodilator therapy in acute myocardial infarction. Circulation. 1973 Dec;48(6):1183–1193. doi: 10.1161/01.cir.48.6.1183. [DOI] [PubMed] [Google Scholar]
  8. Chiariello M., Gold H. K., Leinbach R. C., Davis M. A., Maroko P. R. Comparison between the effects of nitroprusside and nitroglycerin on ischemic injury during acute myocardial infarction. Circulation. 1976 Nov;54(5):766–773. doi: 10.1161/01.cir.54.5.766. [DOI] [PubMed] [Google Scholar]
  9. Come P. C., Flaherty J. T., Baird M. G., Rouleau J. R., Weisfeldt M. L., Greene H. L., Becker L., Pitt B. Reversal by phenylephrine of the beneficial effects of intravenous nitroglycerin in patients with acute myocardial infarction. N Engl J Med. 1975 Nov 13;293(20):1003–1007. doi: 10.1056/NEJM197511132932001. [DOI] [PubMed] [Google Scholar]
  10. EKMEKCI A., TOYOSHIMA H., KWOCZYNSKI J. K., NAGAYA T., PRINZMETAL M. Angina pectoris. IV. Clinical and experimental difference between ischemia with S-T elevation and ischemia with S-T depression. Am J Cardiol. 1961 Mar;7:412–426. doi: 10.1016/0002-9149(61)90485-4. [DOI] [PubMed] [Google Scholar]
  11. Flaherty J. T., Reid P. R., Kelly D. T., Taylor D. R., Weisfeldt M. L., Pitt B. Intravenous nitroglycerin in acute myocardial infarction. Circulation. 1975 Jan;51(1):132–139. doi: 10.1161/01.cir.51.1.132. [DOI] [PubMed] [Google Scholar]
  12. Fozzard H. A., DasGupta D. S. ST-segment potentials and mapping. Theory and experiments. Circulation. 1976 Oct;54(4):533–537. doi: 10.1161/01.cir.54.4.533. [DOI] [PubMed] [Google Scholar]
  13. Gold H. K., Leinbach R. C., Maroko P. R. Propranolol-induced reduction of signs of ischemic injury during acute myocardial infarction. Am J Cardiol. 1976 Nov 23;38(6):689–695. doi: 10.1016/0002-9149(76)90344-1. [DOI] [PubMed] [Google Scholar]
  14. Gold H. K., Leinbach R. C., Sanders C. A. Use of sublingual nitroglycerin in congestive failure following acute myocardial infarction. Circulation. 1972 Nov;46(5):839–845. doi: 10.1161/01.cir.46.5.839. [DOI] [PubMed] [Google Scholar]
  15. Hardarson T., Henning H., O'Rourke R. A., Karliner J. S., Ryan W., Ross J., Jr Variability, reproducibility, and applications of precordial ST-segment mapping following acute myocardial infarction. Circulation. 1978 Jun;57(6):1096–1103. doi: 10.1161/01.cir.57.6.1096. [DOI] [PubMed] [Google Scholar]
  16. Harnarayan C., Bennett M. A., Pentecost B. L., Brewer D. B. Quantitative study of infarcted myocardium in cardiogenic shock. Br Heart J. 1970 Nov;32(6):728–732. doi: 10.1136/hrt.32.6.728. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Heng M. K., Singh B. N., Norris R. M., John M. B., Elliot R. Relationship between epicardial ST-segment elevation and myocardial ischemic damage after experimental coronary artery occlusion in dogs. J Clin Invest. 1976 Dec;58(6):1317–1326. doi: 10.1172/JCI108587. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Hillis L. D., Askenazi J., Braunwald E., Radvany P., Muller J. E., Fishbein M. C., Maroko P. R. Use of changes in the epicardial QRS complex to assess interventions which modify the extent of myocardial necrosis following coronary artery occlusion. Circulation. 1976 Oct;54(4):591–598. doi: 10.1161/01.cir.54.4.591. [DOI] [PubMed] [Google Scholar]
  19. Hirshfeld J. W., Jr, Borer J. S., Goldstein R. E., Barrett M. J., Epstein S. E. Reduction in severity and extent of myocardial infarction when nitroglycerin and methoxamine are administered during coronary occlusion. Circulation. 1974 Feb;49(2):291–297. doi: 10.1161/01.cir.49.2.291. [DOI] [PubMed] [Google Scholar]
  20. Hirshfeld J. W., Jr, Borer J. S., Goldstein R. E., Barrett M. J., Epstein S. E. Reduction in severity and extent of myocardial infarction when nitroglycerin and methoxamine are administered during coronary occlusion. Circulation. 1974 Feb;49(2):291–297. doi: 10.1161/01.cir.49.2.291. [DOI] [PubMed] [Google Scholar]
  21. Irvin R. G., Cobb F. R. Relationship between epicardial ST-segment elevation, regional myocardial blood flow, and extent of myocardial infarction in awake dogs. Circulation. 1977 Jun;55(6):825–832. doi: 10.1161/01.cir.55.6.825. [DOI] [PubMed] [Google Scholar]
  22. Lee G. B., Amplatz K. Selective coronary arteriography. JAMA. 1968 May 6;204(6):444–448. [PubMed] [Google Scholar]
  23. Libby P., Maroko P. R., Bloor C. M., Sobel B. E., Braunwald E. Reduction of experimental myocardial infarct size by corticosteroid administration. J Clin Invest. 1973 Mar;52(3):599–607. doi: 10.1172/JCI107221. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Madias J. E., Venkataraman K., Hodd W. B., Jr Precordial ST-segment mapping 1. Clinical studies in the coronary care unit. Circulation. 1975 Nov;52(5):799–809. doi: 10.1161/01.cir.52.5.799. [DOI] [PubMed] [Google Scholar]
  25. Mantle J. A., Russell R. O., Jr, Moraski R. E., Rackley C. E. Isosorbide dinitrate for the relief of severe heart failure after myocardial infarction. Am J Cardiol. 1976 Feb;37(2):263–268. doi: 10.1016/0002-9149(76)90322-2. [DOI] [PubMed] [Google Scholar]
  26. Maroko P. R., Braunwald E. Modification of myocardial infarction size after coronary occlusion. Ann Intern Med. 1973 Nov;79(5):720–733. doi: 10.7326/0003-4819-79-5-720. [DOI] [PubMed] [Google Scholar]
  27. Maroko P. R. Editorial: Assessing myocardial damage in acute infarcts. N Engl J Med. 1974 Jan 17;290(3):158–159. doi: 10.1056/NEJM197401172900310. [DOI] [PubMed] [Google Scholar]
  28. Maroko P. R., Hillis L. D., Muller J. E., Tavazzi L., Heyndrickx G. R., Ray M., Chiariello M., Distante A., Askenazi J., Salerno J. Favorable effects of hyaluronidase on electrocardiographic evidence of necrosis in patients with acute myocardial infarction. N Engl J Med. 1977 Apr 21;296(16):898–903. doi: 10.1056/NEJM197704212961603. [DOI] [PubMed] [Google Scholar]
  29. Maroko P. R., Kjekshus J. K., Sobel B. E., Watanabe T., Covell J. W., Ross J., Jr, Braunwald E. Factors influencing infarct size following experimental coronary artery occlusions. Circulation. 1971 Jan;43(1):67–82. doi: 10.1161/01.cir.43.1.67. [DOI] [PubMed] [Google Scholar]
  30. Maroko P. R., Libby P., Bloor C. M., Sobel B. E., Braunwald E. Reduction by hyaluronidase of myocardial necrosis following coronary artery occlusion. Circulation. 1972 Sep;46(3):430–437. doi: 10.1161/01.cir.46.3.430. [DOI] [PubMed] [Google Scholar]
  31. Maroko P. R., Libby P., Covell J. W., Sobel B. E., Ross J., Jr, Braunwald E. Precordial S-T segment elevation mapping: an atraumatic method for assessing alterations in the extent of myocardial ischemic injury. The effects of pharmacologic and hemodynamic interventions. Am J Cardiol. 1972 Feb;29(2):223–230. doi: 10.1016/0002-9149(72)90633-9. [DOI] [PubMed] [Google Scholar]
  32. Muller J. E., Maroko P. R., Braunwald E. Evaluation of precordial electrocardiographic mapping as a means of assessing changes in myocardial ischemic injury. Circulation. 1975 Jul;52(1):16–27. doi: 10.1161/01.cir.52.1.16. [DOI] [PubMed] [Google Scholar]
  33. Nielsen B. L. ST-segment elevation in acute myocardial infarction. Prognostic importance. Circulation. 1973 Aug;48(2):338–345. doi: 10.1161/01.cir.48.2.338. [DOI] [PubMed] [Google Scholar]
  34. Page D. L., Caulfield J. B., Kastor J. A., DeSanctis R. W., Sanders C. A. Myocardial changes associated with cardiogenic shock. N Engl J Med. 1971 Jul 15;285(3):133–137. doi: 10.1056/NEJM197107152850301. [DOI] [PubMed] [Google Scholar]
  35. Reid P. R., Taylor D. R., Kelly D. T., Weisfeldt M. L., Humphries J. O., Ross R. S., Pitt B. Myocardial-infarct extension detected by precordial ST-segment mapping. N Engl J Med. 1974 Jan 17;290(3):123–128. doi: 10.1056/NEJM197401172900302. [DOI] [PubMed] [Google Scholar]
  36. Smith E. R., Redwood D. R., McCarron W. E., Epstein S. E. Coronary artery occlusion in the conscious dog. Effects of alterations in arterial pressure produced by nitroglycerin, hemorrhage, and alpha-adrenergic agonists on the degree of myocardial ischemia. Circulation. 1973 Jan;47(1):51–57. doi: 10.1161/01.cir.47.1.51. [DOI] [PubMed] [Google Scholar]
  37. Smith G. T., Soeter J. R., Haston H. H., McNamara J. J. Coronary reperfusion in primates. Serial electrocardiographic and histologic assessment. J Clin Invest. 1974 Dec;54(6):1420–1427. doi: 10.1172/JCI107889. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES