Hemodynamic and metabolic responses to upright exercise in patients with congestive heart failure. Treatment with nitroglycerin ointment.

Mthough a vasodilator drug might favorably alter hemoynamics in resting, supine patients with heart failure, It must be determined If the drug has any unfavorable as well as favorable effects under extremes of real life sfress situations normally encountered by ambulatory patients, especially upright exercise. An adverse response might occur with the addition of pharmacologic vasodilatlon to the metabolic arterlolar dilation accompanying upright exercise. In order to evaluate these factors In a controlled environment, seven NYHA class 2-3 patients with congestive heart failure without angina pectoris or stenotic ‘aIvular lesions performed upright bicycle exercise proand postadmlnlslratlon of a maximally-tolerated dose of 2 percent njfrogIycerln ointment, determined previously by t1tratIo Nitroglycerin therapy resulted In sllghfly Improved cardiac performance at two given submaximal workloads. Also noted was ata higher workload, a d creast d ratio of arteriovenous oxygen difference to cardiacjndex si ggestlve of Increased circulatory reserve. Pulmonary capillary wedge pressur#{231} to aLhodv oxygen consumption, plasma catecholamines, and blood lactates diii nntahpw a statistically significant change after use otnitroglycerin ointment,. nor were symptoms of fatigue or dyspnea improved during exercise. It Is conduded that nltrogjycedn ointment does not remarkably Improve hernodynamics or alter nutrltIonal blood flow to exermuscle iij maxlmal uiwlaht workload. From our data and that of others, It is concluded that_nitroglycerin ointment can be given safely to heart failure patientato Improveresting su plne hemodynamics without IdJreI’SeIy affecting upright exercise performance or ke j dyn mks.