The potential adverse effects of glyceryl trinitrate on myocardial ischaemia were studied using low and high dose infusions in 10 patients with coronary heart disease. Cardiac venous flow was measured by the thermodilution technique and blood was sampled for metabolic studies. Angina pectoris was provoked by atrial pacing before drug infusion and the same heart rate was regained with low and high doses of glyceryl trinitrate. Both doses reduced myocardial ischaemia equally. The low dose of glyceryl trinitrate reduced mean systolic aortic pressure from 145(23) to 128(23) mm Hg and the high dose further to 103(9) mm Hg. Myocardial oxygen uptake decreased owing to a combined reduction in preload and afterload with the low dose and was substantially more reduced with the high dose owing to a further afterload reduction. Transmural perfusion gradient did not change with the low dose of glyceryl trinitrate but fell significantly with the high dose. This fall in myocardial perfusion probably accounts for the lack of further reduction in ischaemia with the high dose. Thus the adverse effects of glyceryl trinitrate infusion are small and do not increase myocardial ischaemia.
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