SIGNIFICANCE OF NITROGLYCERIN-INDUCED HYPOTENSION WITH INFERIOR WALL ACUTE MYOCARDIAL-INFARCTION
SIGNIFICANCE OF NITROGLYCERIN-INDUCED HYPOTENSION WITH INFERIOR WALL ACUTE MYOCARDIAL-INFARCTION
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DOI：
10.1016/0002-9149(89)90525-0
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发表时间：
1989-08-01
影响因子：
2.8
通讯作者：
PASTERNAK, RC
中科院分区：
文献类型：
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作者：
FERGUSON, JJ;DIVER, DJ;PASTERNAK, RC
高达60%的下壁急性心肌梗死（AMI）患者发生低血压。在许多情况下，使用硝酸甘油会引起严重的低血压。为了验证硝酸甘油的这种过度反应可能与右心室（RV）受累有关的假设，我们比较了20例心电图和酶记录的下壁AMI患者和20例记录的下壁AMI患者，硝酸甘油给药后明显低血压（收缩压降低> 30 mm Hg，有症状），但没有低血压。右心室受累的心电图标准为至少2个右胸导联ST段抬高1 mm。20例对硝酸甘油有明显反应的患者中有15例有RV受累的证据，而20例硝酸盐治疗后无高血压的患者中有18例没有RV受累的证据。在一项对28例下壁AMI患者进行的单独分析中，20例患者因硝酸盐引起低血压。因此，在下壁AMI的情况下，对硝酸盐的显著过敏反应提示RV受累。此外，硝酸盐给药后低血压可能是已知的RV梗死患者，在这样的患者中，硝酸盐应谨慎管理。
Up to 60% of patients with inferior wall acute myocardial infarction (AMI) develop hypotension. In many cases, profound hypotension is precipitated by the administration of nitroglycerin. To test the hypothesis that this hypotensive response to nitroglycerin may be related to right ventricular (RV) involvement, we compared 20 patients with electrocardiographic and enzyme-documented inferior wall AMI and marked hypotension (> 30 mm Hg decrease in systolic blood pressure, with symptoms) after nitrate administration, to 20 patients with documented inferior AMI, but without hypotension after administration of nitroglycerin. The presence of RV involvement was determined by electrocardiographic criteria of 1 mm of ST-segment elevation in at least 2 right precordial chest leads. Fifteen of the 20 patients who demonstrated a marked hypotensive response to nitroglycerin had evidence of RV involvement, while in 18 of the 20 patients without hypertension after nitrates there was no evidence of RV involvement. In a separate analysis of 28 patients with documented RV involvement in an inferior AMI, 20 developed hypotension in reponse to nitrates. Thus, in the setting of an inferior AMI, a marked hypotensive response to nitrates suggests the presence of RV involvement. Moreover, hypotension after nitrate administration may be anticipated in patients with known RV infarction, and in such patients, nitrates should be administered carefully.