Bossi M, Cataldo G, Colombo A, Fiorista F, Gentili D, Pirelli S
G Ital Cardiol. 1977;7(9):922-6.
100 patients with acute myocardial infarction were given 5 mg of sublingual isosorbide dinitrate within 36 hours by the onset of their symptoms. 86 patients did not show any unusual effect after the administration of the drug; their heart rate was only slightly increased and their arterial pressure slightly reduced. 14 patients developed severe systemic arterial hypotension, associated with absolute or relative bradycardia, within 30 minutes of receiving the drug. All the patients complained of fainting and sweating, 1 patient developed a syncope. Symptoms were relieved by raising patients legs in 10 cases, by 0.5 mg Atropina e.v. in 4 cases, 1 case required also external cardiac massage. There was no significant difference between the two groups as regard to the location of myocardial infarction nor to the functional class (according to Killip classification). Possible mechanism producing bradycardia, hypotension and lipothymia after nitrates administration are considered. A vagally mediate reflex possibly elicited by a fall in venous return is the most acceptable hypothesis. The study emphasizes the importance of carefull observation of patients receiving sublingual nitrates during acute myocardial infarction, and the rapid response of bradycardia, hypotension and lipothymia following nitrates administration, to a simple therapy, which avoids other potentially hazardous treatments.
100例急性心肌梗死患者在症状发作36小时内舌下含服5毫克硝酸异山梨酯。86例患者用药后未出现任何异常反应；他们的心率仅略有增加，动脉压略有降低。14例患者在用药后30分钟内出现严重的全身性动脉低血压，并伴有绝对或相对心动过缓。所有患者均主诉头晕和出汗，1例患者发生晕厥。10例患者通过抬高双腿症状缓解，4例患者通过静脉注射0.5毫克阿托品缓解，1例患者还需要进行体外心脏按摩。两组在心肌梗死部位和功能分级（根据Killip分级）方面无显著差异。考虑了硝酸酯类药物给药后产生心动过缓、低血压和晕厥的可能机制。静脉回流下降可能引发的迷走神经介导反射是最可接受的假设。该研究强调了在急性心肌梗死期间仔细观察接受舌下硝酸酯类药物治疗患者的重要性，以及硝酸酯类药物给药后心动过缓、低血压和晕厥对简单治疗的快速反应，这种简单治疗避免了其他潜在危险的治疗方法。
