Hemodynamic Effects of Nitroglycerin, Propranolol, and Their Combination in Coronary Heart Disease

The hemodynamic effects of 10 mg of propranolol given intravenously (iv) were stud-ied in 10 patients (group I) with coronary heart disease (CHD). These results were compared with the hemodynamic effects in a similar group of the nine (CHD) patients (group II) who were studied after administration of 0.6 mg of nitroglycerin and then after receiving 10 mg of propranolol iv with a second 0.6-mg dose of nitroglycerin. Measurements were obtained at rest and during exercise: before treatment, after nitro-glycerin alone, after propranolol alone, and after nitroglycerin-propranolol in combina-tion. Pretreatment exercise showed a 125 % increase in mean pulmonary artery pressure (PAP) to 43 mm Hg and a 163 % increase in left ventricular end-diastolic pressure (LVEDP) to 29 mm Hg. Nitroglycerin decreased PAP (-45%) and LVEDP (-66%); as did nitroglycerin-propranolol: PAP (-33%) and LVEDP (-38%). Nitroglycerin reduced tension-time index (TTI)-21%, and increased cardiac index (CI) +17%, heart rate (HR) +10%, left ventricular work index (LVWI) +11%, and left ventricular dp/dt (LV dp/dt) +22%. By contrast, nitroglycerin-propranolol reduced LVWI-14%, LV dp/dt- 30%, TTI- 15%, and HR- 13 % but did not significantly alter CI from pretreat