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Hemodynamic effects of inhaled nitric oxide in right ventricular myocardial infarction and cardiogenic shock.
- Source :
-
Journal of the American College of Cardiology [J Am Coll Cardiol] 2004 Aug 18; Vol. 44 (4), pp. 793-8. - Publication Year :
- 2004
-
Abstract
- Objectives: We sought to determine whether or not inhaled nitric oxide (NO) could improve hemodynamic function in patients with right ventricular myocardial infarction (RVMI) and cardiogenic shock (CS).<br />Background: Inhaled NO is a selective pulmonary vasodilator that can decrease right ventricular afterload.<br />Methods: Thirteen patients (7 males and 6 females, age 65 +/- 3 years) presenting with electrocardiographic, echocardiographic, and hemodynamic evidence of acute inferior myocardial infarction associated with RVMI and CS were studied. After administration of supplemental oxygen (inspired oxygen fraction [F(i)O(2)] = 1.0), hemodynamic measurements were recorded before, during inhalation of NO (80 ppm at F(i)O(2) = 0.90) for 10 min, and 10 min after NO inhalation was discontinued (F(i)O(2) = 1.0).<br />Results: Breathing NO decreased the mean right atrial pressure by 12 +/- 3%, mean pulmonary arterial pressure by 13 +/- 2%, and pulmonary vascular resistance by 36 +/- 8% (all p < 0.05). Nitric oxide inhalation increased the cardiac index by 24 +/- 11% and the stroke volume index by 23 +/- 12% (p < 0.05). The NO administration did not change systemic arterial or pulmonary capillary wedge pressures. Contrast echocardiography identified three patients with a patent foramen ovale and right-to-left shunt flow while breathing at F(i)O(2) = 1.0. Breathing NO decreased shunt flow by 56 +/- 5% (p < 0.05) and was associated with markedly improved systemic oxygen saturation.<br />Conclusions: Nitric oxide inhalation results in acute hemodynamic improvement when administered to patients with RVMI and CS.
- Subjects :
- Administration, Inhalation
Adult
Aged
Aged, 80 and over
Echocardiography
Electrocardiography
Female
Hemodynamics
Humans
Male
Middle Aged
Myocardial Infarction diagnostic imaging
Myocardial Infarction physiopathology
Nitric Oxide administration & dosage
Prospective Studies
Shock, Cardiogenic physiopathology
Treatment Outcome
Vasodilator Agents administration & dosage
Ventricular Dysfunction, Right diagnostic imaging
Ventricular Dysfunction, Right physiopathology
Myocardial Infarction drug therapy
Nitric Oxide therapeutic use
Shock, Cardiogenic drug therapy
Vasodilator Agents therapeutic use
Ventricular Dysfunction, Right drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 0735-1097
- Volume :
- 44
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 15312861
- Full Text :
- https://doi.org/10.1016/j.jacc.2004.05.047