Hemodynamic Effects of Isosorbide Dinitrate in Patients With Rheumatic Heart Disease and Pulmonary Hypertension

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Abstract
The effect of sublingual isosorbide dinitrate on cardiovascular hemodynamics was studies in 1 subject with a normal heart and 5 patients with rheumatic heart disease (3 "pure" mitral stenoses, 2 mitral stenoses with some degree of mitral insufficiency). Although the magnitude of change in cardiac output was not greater than would be expected in a "steady state" study of this type, there was a consistent decrease in cardiac output in all subjects. Heart rate tended to increase. There was a fall in pulmonary "capillary," left atrial and pulmonary artery pressures. Brachial artery pressure fell, but to a lesser degree. Similarly, right ventricular end-diastolic, mean right atrial or left ventricular end-diastolic pressures tended to decrease. There was a slight change in systemic resistance. Total pulmonary artery resistance fell slightly to moderately except in 1 case. There was a decrease in pulmonary "arteriolar" resistance in 2 cases. Evidence was presented that suggests that isosorbide dinitrate administered sublingually in patients with rheumatic heart disease and increased pulmonary pressures has a dilatory effect upon the pulmonary vascular bed, perhaps more on the venous than the arterial side. It is also possible that some pooling takes place in the systemic vascular bed. Since isosorbide dinitrate causes no major change in heart rate or significant decrease in cardiac output in the doses used, isosorbide dinitrate could possibly be used with some benefit in patients with pulmonary hypertension secondary to increased pulmonary venous pressure.