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. 1973 Apr;52(4):905–911. doi: 10.1172/JCI107255

Nitroglycerin and Heterogeneity of Myocardial Blood Flow REDUCED SUBENDOCARDIAL BLOOD FLOW AND VENTRICULAR CONTRACTILE FORCE

Robert Forman 1, Edward S Kirk 1, James M Downey 1, Edmund H Sonnenblick 1
PMCID: PMC302338  PMID: 4632692

Abstract

The effects of both intracoronary and intravenous administration of nitroglycerin on transmural distribution of blood flow in the left ventricle after partial coronary artery occlusion was investigated using two independent methods. In 16 open chest, anesthetized dogs, tubing supplying the cannulated left coronary artery was partially occluded. Strain gauges sutured paralled to superficial and deep fibers of the myocardium separately recorded the contractile force of each layer. With occlusion set so that depression of the deep contractile force was imminent. 12 μg intracoronary nitroglycerin in seven dogs depressed only the deep contractile force without changing systemic hemodynamics. Intravenous administration of 180 μg nitroglycerin in nine dogs resulted in a decrease of deep contractile force and aortic pressure often associated with an increase in superficial contractile force. Distribution of myocardial blood flow during peak coronary flow after intracoronary administration of nitroglycerin or during a decrease in aortic pressure after intravenous nitroglycerin administration was determined by the tissue uptake of an intracoronary bolus of rubidium-80. This was compared with the uptake of potassium-42 injected before nitroglycerin. Intravenous or intracoronary administration of nitroglycerin caused a significant reduction in subendocardial blood flow with a decrease in the subendocardial/subepicardial ratio of isotope.

These experiments suggest that under conditions of acute partial coronary occlusion, the autoregulatory response results in more fully dilated subendocardial vessels causing them to be less responsive to nitroglycerin. Nitroglycerin may then reduce the vascular resistance in the subepicardial more than the subendocardial vessels, resulting in a “steal” of blood flow from deep to superficial myocardium.

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Selected References

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

  1. Becker L. C., Fortuin N. J., Pitt B. Effect of ischemia and antianginal drugs on the distribution of radioactive microspheres in the canine left ventricle. Circ Res. 1971 Feb;28(2):263–269. doi: 10.1161/01.res.28.2.263. [DOI] [PubMed] [Google Scholar]
  2. Domenech R. J., Hoffman J. I., Noble M. I., Saunders K. B., Henson J. R., Subijanto S. Total and regional coronary blood flow measured by radioactive microspheres in conscious and anesthetized dogs. Circ Res. 1969 Nov;25(5):581–596. doi: 10.1161/01.res.25.5.581. [DOI] [PubMed] [Google Scholar]
  3. FAM W. M., MCGREGOR M. EFFECT OF CORONARY VASODILATOR DRUGS ON RETROGRADE FLOW IN AREAS OF CHRONIC MYOCARDIAL ISCHEMIA. Circ Res. 1964 Oct;15:355–364. doi: 10.1161/01.res.15.4.355. [DOI] [PubMed] [Google Scholar]
  4. GORLIN R., BRACHFELD N., MACLEOD C., BOPP P. Effect of nitroglycerin on the coronary circulation in patients with coronary artery disease or increased left ventricular work. Circulation. 1959 May;19(5):705–718. doi: 10.1161/01.cir.19.5.705. [DOI] [PubMed] [Google Scholar]
  5. LOVE W. D., BURCH G. E. Differences in the rate of Rb86 uptake by several regions of the myocardium of control dogs and dogs receiving 1-norepinephrine or pitressin. J Clin Invest. 1957 Mar;36(3):479–484. doi: 10.1172/JCI103445. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. LOVE W. D., BURCH G. E. Influence of the rate of coronary plasma flow on the extraction of Rb86 from coronary blood. Circ Res. 1959 Jan;7(1):24–30. doi: 10.1161/01.res.7.1.24. [DOI] [PubMed] [Google Scholar]
  7. Mathes P., Rival J. Effect of nitroglycerin on total and regional coronary blood flow in the normal and ischaemic canine myocardium. Cardiovasc Res. 1971 Jan;5(1):54–61. doi: 10.1093/cvr/5.1.54. [DOI] [PubMed] [Google Scholar]
  8. Moir T. W., DeBra D. W. Effect of left ventricular hypertension, ischemia and vasoactive drugs on the myocardial distribution of coronary flow. Circ Res. 1967 Jul;21(1):65–74. doi: 10.1161/01.res.21.1.65. [DOI] [PubMed] [Google Scholar]
  9. RUSSEK H. I., URBACH K. F., ZOHMAN B. L. Paradoxical action of glyceryl trinitrate (nitroglycerin) in coronary patients. J Am Med Assoc. 1955 Jul 23;158(12):1017–1021. doi: 10.1001/jama.1955.02960120017006. [DOI] [PubMed] [Google Scholar]
  10. SALISBURY P. F., CROSS C. E., RIEBEN P. A. ACUTE ISCHEMIA OF INNER LAYERS OF VENTRICULAR WALL. Am Heart J. 1963 Nov;66:650–656. doi: 10.1016/0002-8703(63)90321-1. [DOI] [PubMed] [Google Scholar]
  11. SAPIRSTEIN L. A. Regional blood flow by fractional distribution of indicators. Am J Physiol. 1958 Apr;193(1):161–168. doi: 10.1152/ajplegacy.1958.193.1.161. [DOI] [PubMed] [Google Scholar]
  12. Streeter D. D., Jr, Spotnitz H. M., Patel D. P., Ross J., Jr, Sonnenblick E. H. Fiber orientation in the canine left ventricle during diastole and systole. Circ Res. 1969 Mar;24(3):339–347. doi: 10.1161/01.res.24.3.339. [DOI] [PubMed] [Google Scholar]
  13. Williams J. F., Jr, Glick G., Braunwald E. Studies on cardiac dimensions in intact unanesthetized man. V. Effects of nitroglycerin. Circulation. 1965 Nov;32(5):767–771. doi: 10.1161/01.cir.32.5.767. [DOI] [PubMed] [Google Scholar]
  14. Winbury M. M., Howe B. B., Weiss J. R. Effect of nitroglycerin and dipyridamole on epicardial and endocardial oxygen tension--further evidence for redistribution of myocardial blood flow. J Pharmacol Exp Ther. 1971 Jan;176(1):184–199. [PubMed] [Google Scholar]

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