INTRAVENOUS NITROGLYCERIN TOLERANCE IN PATIENTS WITH ISCHEMIC CARDIOMYOPATHY AND CONGESTIVE-HEART-FAILURE

A daily nitrate-free interval (NFI) lasting 4-7 hours was instituted i n four patients with severe congestive heart failure secondary to myoc ardial ischemia who were awaiting orthotopic heart transplantation. Th e duration of intravenous nitroglycerin therapy ranged from 14-55 days ,and the maximum dosage was 50-400 mu g/minute. Anginal events occurre d more frequently during the NFI than during intravenous therapy. An N FI of 8-12 hours reduces tolerance in patients with congestive heart f ailure and stable angina. However, the experience in these patients wi th recurrent ischemia does not support its use to prevent ischemic eve nts during hospitalization.