Nitroprusside therapy. Treatment of hypertensive patients with recurrent resting chest pain, ST-segment elevation, and ventricular arrhythmias
D. Mukherjee, M. S. Feldman and R. H. Helfant
Five hypertensive patients with acute myocardial infarction and persistent
postinfarction hypertension who experienced severe and recurrent resting
chest pain, ST elevations, and severe ventricular arrhythmias refractory to
conventional treatment with bed rest, sedation, oxygen inhalation,
nitrates, and antiarrhythmic agents received sodium nitroprusside by
continuous intravenous infusion, titrated to reduce systolic blood pressure
to 100 to 110 mm Hg. Treatment resulted in noticeable improvement in
symptoms, reduction in ST elevations, and abolition of ventricular
arrhythmias in all five patients. In four patients, cessation of
nitroprusside infusion after 48 hours resulted in prompt recurrence of
hypertension, chest pain, ST-segment elevations, and ventricular
arrhythmias. These were all rapidly reversed following reinstitution of the
nitroprusside therapy for seven to eight days, strongly suggesting a
cause-and-effect relationship. Nitroprusside infusion in these patients
suggests a potentially important use for such therapy in this clinical
setting.
