Contraindications
Allergy: There is only one described case of an anaphylactic reaction to intravenous nitroglycerin
Weiss L, Bady N, Horn RW, Thaler H. Handle with care ... nitroglycerin anaphylaxis. Ann Allergy Asthma Immunol. 2009;103(6):554-6. Available from: https://pubmed.ncbi.nlm.nih.gov/20084849/
Ramey J, Levy RF. Allergic and nonallergic reactions to nitroglycerin. Allergy Asthma Proc. 2006;27(3):213-6. Available from: https://pubmed.ncbi.nlm.nih.gov/16913273/
Aquilina S, Fuller HF, Beck MJ. Allergic reactions to glyceryl trinitrate and isosorbide dinitrate demonstrating cross-sensitivity. Clin Exp Dermatol. 2002;27(8):658-9. Available from: https://pubmed.ncbi.nlm.nih.gov/12472550/
Interaction between phosphodiesterase-inhibitors and nitroglycerin: This seems to be negligible >12 hours after intake, and it is safe to give nitroglycerine < 12 hours if one dose-adjusts
Kernohan A, Matin M, Hanley DM, Thomson SW, Wood M, Richmond JL. An oral yohimbine/L-arginine combination (NMI 861) for the treatment of male erectile dysfunction: a pharmacokinetic, pharmacodynamic and interaction study with intravenous nitroglycerine in healthy male subjects. Br J Clin Pharmacol. 2005;59(1):136-44. Available from: https://pubmed.ncbi.nlm.nih.gov/15606445/
Ishikura F, Beppu S, Hamada T, Khandheria BK, Seward JB, Nehra A. Effects of sildenafil citrate (Viagra) combined with nitrate on the heart. Circulation. 2000;102(20):2516-21. Available from: https://www.ahajournals.org/doi/abs/10.1161/01.cir.102.20.2516
Swearingen D, Norman A, Munt S, Pasquale CA. Hemodynamic effect of avanafil and glyceryl trinitrate coadministration. Drugs Context. 2013;2013:212250. Available from: https://pubmed.ncbi.nlm.nih.gov/24432037/
Kloner R. Pharmacology and drug interaction effects of the phosphodiesterase 5 inhibitors: focus on α-blocker interactions. Am J Cardiol. 2005;96(12):42-6.
Masoud MJ, Dickson SP. Phosphodiesterase type 5 inhibitors and oral nitrates in male patients with ischemic heart disease. Curr Cardiol Rep. 2023;25(6):490-7. Available from: https://pubmed.ncbi.nlm.nih.gov/37074567/
Parker JD, Bauersachs J, Weber DJ, Kates MJ, Siegel RL, Weil HW, et al. Safety of intravenous nitroglycerin after administration of sildenafil citrate to men with coronary artery disease: a double-blind, placebo-controlled, randomized, crossover trial. Crit Care Med. 2007;35(8):1865-9. Available from: https://pubmed.ncbi.nlm.nih.gov/17522570/
Weber DJ, Siegel RL, Augello MJ, Mencarelli GJ. Sildenafil citrate and blood-pressure-lowering drugs: results of drug interaction studies with an organic nitrate and a calcium antagonist. Am J Cardiol. 1999;83(5A):24C-28C. Available from: https://pubmed.ncbi.nlm.nih.gov/10078539/
Nitroglycerin in right ventricular myocardial infarction: There is no evidence to support that nitroglycerine is contraindicated in right ventricular myocardial infarction
Bosson N, Isakson B, Morgan JA, Kaji AH, Uner A, Hurley K, et al. The safety and efficacy of nitroglycerin use by paramedics for treatment of ST elevation myocardial infarction. Ann Emerg Med. 2017;70(4 Suppl).
Wilkinson-Stokes M, Brady J, Scheitz S. Adverse events from nitrate administration during right ventricular myocardial infarction: a systematic review and meta-analysis. Emerg Med J. 2023;40(2):81-8. Available from: https://pubmed.ncbi.nlm.nih.gov/36180168/
McConnell AH, Davis M, Aarsen KV, Columbus M, Lewell M. LO33: Prehospital adverse events associated with nitroglycerin use in STEMI patients with right ventricle infarction. Can J Emerg Med. 2017;19(S1).
Robichaud L, Rutsch DR, Pinsonneault MH, Lambert S, Verreault C, Ouellette XX, et al. Prehospital nitroglycerin safety in inferior ST elevation myocardial infarction. Prehosp Emerg Care. 2016;20(1):55-61. Available from: https://pubmed.ncbi.nlm.nih.gov/26024432/
Aortic stenosis: Aortic stenosis is to be considered a relative contraindication. In the context of SCAPE the benefits outweigh the risks.
Claveau D, Mason A, Atkinson J, et al. Complications associated with nitrate use in patients presenting with acute pulmonary edema and concomitant moderate or severe aortic stenosis. Ann Emerg Med. 2015;66(4):355-62.
Hypotension: There is a paucity of knowledge of the effects of nitroglycerin in hypotension. There are no studies on this specifically. Cases of patients receiving nitroglycerine despite hypotension have been described with no serious adverse events occurring.
Wilson S, Kilgannon GM, Mahesh SR, Pate JD, Mills AP, Levy PD. Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure. Am J Emerg Med. 2017;35(1):84-90. Available from: https://pubmed.ncbi.nlm.nih.gov/27825693/
Studies from 1990 and forward on adverse events in nitroglycerin
Below follow all studies (that I have been able to identify) reporting on adverse events following nitroglycerine administration since 1990. Putting the information form these 95 817 cases included in these studies together implies an incidence of: 2 % transient hypotension; 1,5-2 % bradycardia; and 0.2 % altered level of consciousness.
Popp L, Lott LM, Alt NP, Swanson JP. Adverse events after prehospital nitroglycerin administration in a nationwide registry analysis. Am J Emerg Med. 2021;50:42-50. Available from: https://pubmed.ncbi.nlm.nih.gov/34390902/
Engelberg S, Smith AJ, Montague JT, Seward HC, Holland MH. Effects of prehospital nitroglycerin on hemodynamics and chest pain intensity. Prehosp Emerg Care. 2000;4(4):318-21. Available from: https://pubmed.ncbi.nlm.nih.gov/11045405/
Proulx M, Le De Medouze L, Rutsch DR, Verreault C, Lambert S, Swick J. Prehospital nitroglycerin in tachycardic chest pain patients: a risk for hypotension or not? Prehosp Emerg Care. 2017;21(1):22-8. Available from: https://pubmed.ncbi.nlm.nih.gov/27690207/
McConnell AH, Davis M, Aarsen KV, Columbus M, Lewell M. LO33: Prehospital adverse events associated with nitroglycerin use in STEMI patients with right ventricle infarction. Can J Emerg Med. 2017;19(S1).
Robichaud L, Rutsch DR, Pinsonneault MH, Lambert S, Verreault C, Ouellette XX, et al. Prehospital nitroglycerin safety in inferior ST elevation myocardial infarction. Prehosp Emerg Care. 2016;20(1):55-61. Available from: https://pubmed.ncbi.nlm.nih.gov/26024432/
Wilson S, Kilgannon GM, Mahesh SR, Pate JD, Mills AP, Levy PD. Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure. Am J Emerg Med. 2017;35(1):84-90. Available from: https://pubmed.ncbi.nlm.nih.gov/27825693/
Bosson N, Isakson B, Morgan JA, Kaji AH, Uner A, Hurley K, et al. The safety and efficacy of nitroglycerin use by paramedics for treatment of ST elevation myocardial infarction. Ann Emerg Med. 2017;70(4 Suppl)
Wuartz C. Safety of prehospital nitroglycerin. Ann Emerg Med. 1994;23(1):31-6.
Richards JR, Derlet RW, Albertson TE, Lange RA, Horowitz BZ, Olson KR, et al. Treatment of cocaine cardiovascular toxicity: a systematic review. Clin Toxicol (Phila). 2016;54(5):345-61. Available from: https://pubmed.ncbi.nlm.nih.gov/26919414/ (Multiple studies and case reports on the studies and case-reports where nitroglycerin has been used as treatment in cocaine-intoxication are described. The review is uses instead of referring to all included studies individually)
Patrick C, Farmer LF, Wells BW, Walters MW, Kent RK, Koenig MD, et al. Safety of prehospital intravenous bolus dose nitroglycerin in patients with acute pulmonary edema: a 4-year review. JACEP Open. 2023;4(6). Available from: https://pubmed.ncbi.nlm.nih.gov/38073706/
Mahmoud Shawky Abdelmoneum MIE. Bolus versus continuous infusion of nitroglycerin for the treatment of acute hypertensive heart failure. Int J Cardiovasc Acad [Internet]. 2022 [cited 2024 Sep 21]. Available from: https://ijcva.org/articles/bolus-versus-continuous-infusion-of-nitroglycerin-for-the-treatment-of-acute-hypertensive-heart-failure/doi/ijca.ijca_48_21
Cotter G. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet. 1998;351(9100):389-93.
Clemency BM, Thompson JJ, Tan GN, Limbourg HA. Prehospital high-dose sublingual nitroglycerin rarely causes hypotension. Prehosp Disaster Med. 2013;28(5):505-10. Available from: https://pubmed.ncbi.nlm.nih.gov/23962769/
Houseman B, MacDonald AN, Olson WD, Samuelson D, Auerbach MS. High-dose nitroglycerin infusion description of safety and efficacy in sympathetic crashing acute pulmonary edema: The HI-DOSE SCAPE study. Am J Emerg Med. 2023;63:46-52. Available from: https://pubmed.ncbi.nlm.nih.gov/36327753/
Siddiqua N, Mian R, Shahid AK, Noor J, Bartlett J, Aryan P, et al. High-dose versus low-dose intravenous nitroglycerine for sympathetic crashing acute pulmonary edema: a randomized controlled trial. Emerg Med J. 2024;41(2):139-144. Available from: https://pubmed.ncbi.nlm.nih.gov/38050078/
Patrick C, Wells BW, Anderson J, Koenig RK, Austin EA, Reiser CJ, et al. Feasibility, effectiveness, and safety of prehospital intravenous bolus dose nitroglycerin in patients with acute pulmonary edema. Prehosp Emerg Care. 2020;24(6):767-74. Available from: https://pubmed.ncbi.nlm.nih.gov/31900011/
Mallick P, Zaman S, Dhamrait G, et al. A protocol of bolus-dose nitroglycerin and non-invasive ventilation to avert intubation in emergency department acute pulmonary edema. Crit Care Med. 2011;39(12 Suppl):67. doi: 10.1097/01.ccm.0000408627.24229.88
Kelly G. Low- versus high-dose nitroglycerin infusion in the management of acute pulmonary edema. Am J Emerg Med. 2023;65:71-5.
Levy P, Compton S, Welch RD, Dunne G, Jones AE, Penning N, et al. Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Ann Emerg Med [Internet]. 2007 Aug [cited 2024 Feb 24];50(2):144-52. Available from: https://pubmed.ncbi.nlm.nih.gov/17509731/
Mathew R, Kaushik A, Shah A, Welch S, Aryan P. High-dose nitroglycerin bolus for sympathetic crashing acute pulmonary edema: a prospective observational pilot study. J Emerg Med [Internet]. 2021 Sep [cited 2024 Feb 24];61(3):308-13. Available from: https://pubmed.ncbi.nlm.nih.gov/34215472/
Nashed A, Jain JR, Lapierre S, Hamidpour M. Bolus intravenous nitroglycerin treatment of ischemic chest pain in the ED. Am J Emerg Med [Internet]. 1994 May [cited 2024 Feb 24];12(3):250-3. Available from: https://pubmed.ncbi.nlm.nih.gov/8179732/
Nashed A. Intravenous nitroglycerin boluses in treating patients with cardiogenic pulmonary edema. Am J Emerg Med. 1995;13(5):612-3.
Serious adverse events
Serious adverse events seem to be extremely rare. Transient asystole have been described in 6 cases between 1990 and August 2024.
Pennington, Medicine 2018|Emergency. Asystole Following Nitroglycerin: A Review of Two Cases | MDedge [Internet]. [cited 2024 Sep 21]. Available from: https://mdedge.com/emed-journal/article/171774/cardiology/asystole-following-nitroglycerin-review-two-cases
Wuartz C. Safety of prehospital nitroglycerin. Ann Emerg Med. 1994;23(1):31-6.
Younas F, Jamshaid M, Butt A, Durrani M, Paudel KC, Christenson JF. Transient complete heart block and isolated ventricular asystole with nitroglycerin. J Cardiovasc Med (Hagerstown) [Internet]. 2012 Aug [cited 2024 Feb 24];13(8):546-50. Available from: https://pubmed.ncbi.nlm.nih.gov/21119527/
Thomas J, Smith E, Haffner P. Nitroglycerin-induced asystole: a common therapy with a rare adverse effect. Am J Med [Internet]. 2016 Oct [cited 2024 Feb 24];129(10). Available from: https://pubmed.ncbi.nlm.nih.gov/27430406/
Brandes W, Santiago T, Limacher M. Nitroglycerin-induced hypotension, bradycardia, and asystole: report of a case and review of the literature. Clin Cardiol. 1990;13(10):741-4.
Boyle. A dramatic drop in blood pressure following prehospital GTN administration. ResearchGate [Internet]. 2003 [cited 2024 Feb 24]. Available from: https://www.researchgate.net/publication/6456272_A_dramatic_drop_in_blood_pressure_following_prehospital_GTN_administration
Buckley R, Rowe RR. Symptomatic bradycardia following the administration of sublingual nitroglycerin. Am J Emerg Med [Internet]. 1993 May [cited 2024 Feb 24];11(3):280-2. Available from: https://pubmed.ncbi.nlm.nih.gov/8489673/
Brywczynsk J. Not the Nitro? Patient goes into prehospital V-fib arrest following nitroglycerin. JEMS [Internet]. 2009 [cited 2024 Feb 24]. Available from: https://www.jems.com/administration-and-leadership/not-nitro-patient-goes-prehosp/
Methemoglobinemia has been described in several case reports form the 1980s. I have not been able to find any reported cases in more modern literature, including in the studies of high dose nitroglycerine for the treatment of SCAPE.
Robicsek F. Acute methemoglobinemia during cardiopulmonary bypass caused by intravenous nitroglycerin infusion. J Thorac Cardiovasc Surg [Internet]. 1985 Dec [cited 2024 Feb 24];90(6):951-3. Available from: https://pubmed.ncbi.nlm.nih.gov/3934466/
Kaplan K, Martinez T, Jr T, Pappas M, Dean R. Association of methemoglobinemia and intravenous nitroglycerin administration. Am J Cardiol [Internet]. 1985 Jan 1 [cited 2024 Feb 24];55(1):181-2. Available from: https://pubmed.ncbi.nlm.nih.gov/3917597/
Saxon S, Smith ME. Effects of continuous infusion of intravenous nitroglycerin on methemoglobin levels. Am J Cardiol [Internet]. 1985 Jan 9 [cited 2024 Feb 24];56(7):486-7. Available from: https://pubmed.ncbi.nlm.nih.gov/3929581/
Bonchek R, Ruschhaupt H, Pifarre DD, Hanley SH, Emery MR, Stertzer JJ, et al. Methemoglobinemia from intravenous nitroglycerin: a word of caution. Ann Thorac Surg [Internet]. 1987 Mar [cited 2024 Feb 24];43(3):341-3. Available from: https://pubmed.ncbi.nlm.nih.gov/3103557/
Marcus JB, Enzenauer RJ. Methemoglobinemia from overdose of nitroglycerin. JAMA [Internet]. 1980 Jul 25 [cited 2024 Feb 24];244(4):314-5. Available from: https://pubmed.ncbi.nlm.nih.gov/6771417/
Gibson RG, Beatty Hunter J, Raabe D Jr, Manjoney L, Ittleman P. Methemoglobinemia produced by high-dose intravenous nitroglycerin. Ann Intern Med [Internet]. 1982 Dec [cited 2024 Feb 24];96(5):615-6. Available from: https://www.acpjournals.org/doi/10.7326/0003-4819-96-5-615
Below follow all high-dose nitroglycerine studies (that I have been able to identify)
Cotter G. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet. 1998;351(9100):389–93.
Sharon A, Izbicki G, Shacham E, Moskowitz Y, Magen O, Peled R, et al. High-dose intravenous isosorbide-dinitrate is safer and better than Bi-PAP ventilation combined with conventional treatment for severe pulmonary edema. J Am Coll Cardiol [Internet]. 2000 Sep [cited 2024 Feb 24];36(3):832-7. Available from: https://pubmed.ncbi.nlm.nih.gov/10987607/
Levy P, Compton S, Welch RD, Dunne G, Jones AE, Penning N, et al. Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Ann Emerg Med [Internet]. 2007 Aug [cited 2024 Feb 24];50(2):144-52. Available from: https://pubmed.ncbi.nlm.nih.gov/17509731/
Mallick P, et al. 258: A protocol of bolus-dose nitroglycerin and non-invasive ventilation to avert intubation in emergency department acute pulmonary edema. Crit Care Med. 2011;39(12):67. DOI: 10.1097/01.ccm.0000408627.24229.88
Wilson S, Khan GM, Miller SR, Porter JD, Meade AP, Ligon PD. Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure. Am J Emerg Med [Internet]. 2017 Jan [cited 2024 Feb 24];35(1):128-32. Available from: https://pubmed.ncbi.nlm.nih.gov/27825693/
Paone S, Chaudhry L, Bag S, Pritchard S. Recognition of Sympathetic Crashing Acute Pulmonary Edema (SCAPE) and use of high-dose nitroglycerin infusion. Am J Emerg Med [Internet]. 2018 Aug [cited 2024 Feb 24];36(8):1469-73. Available from: https://pubmed.ncbi.nlm.nih.gov/29776826/
Hsieh Y, Lin TY, Kao JS, Hsiao HL, Chou CF. Treating acute hypertensive cardiogenic pulmonary edema with high-dose nitroglycerin. Turk J Emerg Med [Internet]. 2018 Feb 2 [cited 2024 Feb 24];18(1):1-5. Available from: https://pubmed.ncbi.nlm.nih.gov/29942881/
Patrick C, Wong B, Aherne J, Kratz RK, Adams EA, Reardon C, et al. Feasibility, effectiveness, and safety of prehospital intravenous bolus dose nitroglycerin in patients with acute pulmonary edema. Prehosp Emerg Care [Internet]. 2020 Dec [cited 2024 Feb 24];24(6):808-15. Available from: https://pubmed.ncbi.nlm.nih.gov/31900011/
Stemple K, Dietrich KM, Price BA, Schuler M, Brunnett E, Briese M. High-dose nitroglycerin infusion for the management of sympathetic crashing acute pulmonary edema (SCAPE): a case series. Am J Emerg Med [Internet]. 2021 Jun [cited 2024 Feb 24];44:153-6. Available from: https://pubmed.ncbi.nlm.nih.gov/32278569/
Mathew R, Kaushik A, Shah A, Welch S, Aryan P. High-dose nitroglycerin bolus for sympathetic crashing acute pulmonary edema: a prospective observational pilot study. J Emerg Med [Internet]. 2021 Sep [cited 2024 Feb 24];61(3):308-13. Available from: https://pubmed.ncbi.nlm.nih.gov/34215472/
Gyory M, Singh A, Levy PD, Tucker MJ. Ultra-high dose intravenous nitroglycerin in an ESRD patient with acutely decompensated heart failure. J Am Coll Emerg Physicians Open [Internet]. 2021 Feb 3 [cited 2024 Feb 24];2(2). Available from: https://pubmed.ncbi.nlm.nih.gov/33718922/
Mahmoud Shawky Abdelmoneum MI. Bolus versus continuous infusion of nitroglycerin for the treatment of acute hypertensive heart failure [Internet]. Int J Cardiovasc Acad; 2022 [cited 2024 Sep 21]. Available from: https://ijcva.org/articles/bolus-versus-continuous-infusion-of-nitroglycerin-for-the-treatment-of-acute-hypertensive-heart-failure/doi/ijca.ijca_48_21
Kelly G. Low- versus high-dose nitroglycerin infusion in the management of acute pulmonary edema. Am J Emerg Med. 2023;65:71-5.
Houseman B, Matthews A, O’Neill WD, Dodson SD, Madah-Amiri A. High-dose nitroglycerin infusion description of safety and efficacy in sympathetic crashing acute pulmonary edema: The HI-DOSE SCAPE study. Am J Emerg Med [Internet]. 2023 Jan [cited 2024 Feb 24];63:157-63. Available from: https://pubmed.ncbi.nlm.nih.gov/36327753/
Siddiqua N, Billah R, Samad AK, Javed N, Bailey J, Aryan P, et al. High-dose versus low-dose intravenous nitroglycerine for sympathetic crashing acute pulmonary edema: a randomised controlled trial. Emerg Med J [Internet]. 2024 Jan 22 [cited 2024 Feb 24];41(2):87-92. Available from: https://pubmed.ncbi.nlm.nih.gov/38050078/
Patrick C, Faulk LF, Wong B, Morris W, Kratz RK, Aherne J, et al. Safety of prehospital intravenous bolus dose nitroglycerin in patients with acute pulmonary edema: A 4-year review. J Am Coll Emerg Physicians Open [Internet]. 2023 Aug 12 [cited 2024 Feb 24];4(6). Available from: https://pubmed.ncbi.nlm.nih.gov/38073706/
Siddiqua N, Bailey J, Samad AK, Kassam A, Javed N. Taming the tiger: Ultra-high dose nitroglycerin in managing sympathetic crashing acute pulmonary edema patient. Am J Emerg Med [Internet]. 2023 May [cited 2024 Feb 24];67:232-6. Available from: https://pubmed.ncbi.nlm.nih.gov/37002114/
Raggi J, O’Neill TW, Stanley DJ. Nicardipine: When high dose nitrates fail in treating heart failure. Am J Emerg Med [Internet]. 2021 Jul [cited 2024 Feb 24];45:319-22. Available from: https://pubmed.ncbi.nlm.nih.gov/33358327/
López-Rivera F, Castilla-Herrero MA, Cepeda-Cuervo C, Rivera-García A, Vallejo-Fernández VF, Rosado-González JG, et al. Treatment of hypertensive cardiogenic edema with intravenous high-dose nitroglycerin in a patient presenting with signs of respiratory failure: A case report and review of the literature. Am J Case Rep [Internet]. 2019 Jan 21 [cited 2024 Feb 24];20. Available from: https://pubmed.ncbi.nlm.nih.gov/30662059/
Case reports of nitroglycerin being used well outside routine. Cases of cardiac arrest and cardiogenic shock.
Guglin M, Postler G. High dose nitroglycerin treatment in a patient with cardiac arrest: a case report. J Med Case Reports. 2009;3(1):1–4.
Babapoor-Farrokhran S, Kaur A, Gill D, Gill A, Balaratnam S, Khraishah S. Peripheral administration of nitroglycerin in pulseless ventricular tachycardia due to cocaine-induced coronary vasospasm. Cardiovasc Toxicol [Internet]. 2021 Jun [cited 2024 Feb 24];21(6):514-7. Available from: https://pubmed.ncbi.nlm.nih.gov/33534027/
Ward W. High-dose intravenous nitroglycerin during cardiopulmonary resuscitation for refractory cardiac arrest. Am J Cardiol. 1984;53(11):1725.
Kruzliak P, Pechanova O, Kosmala T. New perspectives of nitric oxide donors in cardiac arrest and cardiopulmonary resuscitation treatment. Heart Fail Rev [Internet]. 2014 May [cited 2024 Jun 23];19(3):353-63. Available from: https://pubmed.ncbi.nlm.nih.gov/23712508/
Stefaniotou A. The effects of nitroglycerin during cardiopulmonary resuscitation. Eur J Pharmacol. 2014;734:42–9.
Two studies report that early nitroglycerine is associated with increased survival in myocardial infarction. Causality is not implied.
Strandmark R, Herlitz J, Claesson A, Axelsson C, Bremer A, Kurland L, et al. Determinants of pre-hospital pharmacological intervention and its association with outcome in acute myocardial infarction. Scand J Trauma Resusc Emerg Med [Internet]. 2015 Jan 12 [cited 2024 Feb 24];23:5. Available from: https://pubmed.ncbi.nlm.nih.gov/26626732/
Miró Ó, Llorens P, Ferré Y, Daniel B, Torres K, Pérez HP, et al. Early intravenous nitroglycerin use in prehospital setting and in the emergency department to treat patients with acute heart failure: Insights from the EAHFE Spanish registry. Int J Cardiol [Internet]. 2021 Jan 12 [cited 2024 Feb 24];344:82–7. Available from: https://pubmed.ncbi.nlm.nih.gov/34543690/
Other useful references
Freund Y, Chouihed T, Delaunay Q, Loiseau S, Yordanov Y, Goulet H, et al. Effect of an emergency department care bundle on 30-day hospital discharge and survival among elderly patients with acute heart failure: The ELISABETH randomized clinical trial. JAMA [Internet]. 2020 Nov 17 [cited 2024 Jun 22];324(19):1948–56. Available from: https://pubmed.ncbi.nlm.nih.gov/33201202/
van den Born BJ, Lip GYH, Brguljan-Hitij J, Cremer A, Segura J, Morales E, et al. ESC council on hypertension position document on the management of hypertensive emergencies. Eur Heart J Cardiovasc Pharmacother [Internet]. 2019 Jan [cited 2024 Jun 23];5(1):37–46. Available from: https://pubmed.ncbi.nlm.nih.gov/30165588/
Uhlig K, Levitan EB, Thomas JD, Schulz KF, Reynolds MW, Siegfried N, et al. Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome. Cochrane Database Syst Rev [Internet]. 2020 May 11 [cited 2024 Jun 22];2020(11). Available from: https://pubmed.ncbi.nlm.nih.gov/33152122/
Alexander P, Lavery A, Courtney J, Little P, Peacock PS, Shepherd AB, et al. Lack of evidence for intravenous vasodilators in ED patients with acute heart failure: a systematic review. Am J Emerg Med [Internet]. 2015 Feb [cited 2024 Feb 24];33(2):312–6. Available from: https://pubmed.ncbi.nlm.nih.gov/25530194/
Alzahri M, Ali R, Peterson WF. Nitrates as a treatment of acute heart failure. Card Fail Rev [Internet]. 2016 May [cited 2024 Jun 27];2(1):36–9. Available from: https://pubmed.ncbi.nlm.nih.gov/28785453/
Twiner M, Hendrikse J, Wilkinson RJ, Lim PD. Nitroglycerin use in the emergency department: current perspectives. Open Access Emerg Med [Internet]. 2022 Sep 7 [cited 2024 Jun 22];14:99–110. Available from: https://pubmed.ncbi.nlm.nih.gov/35847764/
Wakai A, McCabe A, Roberts K, Baird SC, Skelly R, Deakin D, et al. Nitrates for acute heart failure syndromes. Cochrane Database Syst Rev [Internet]. 2013 Jun 8 [cited 2024 Feb 24];2013(8). Available from: https://pubmed.ncbi.nlm.nih.gov/23922186/
Komaki S, Matsuda Y, Takahashi H, Kiyokawa K, Yoshida Y, Kuwabara K, et al. Nitroglycerin use and adverse clinical outcomes in elderly patients with acute coronary syndrome. Open Heart [Internet]. 2024 Nov 1 [cited 2024 Feb 24];11(1). Available from: https://pubmed.ncbi.nlm.nih.gov/38216173/
Wang K, Szeto KC. Role of high-dose intravenous nitrates in hypertensive acute heart failure. Am J Emerg Med [Internet]. 2020 Jan [cited 2024 Feb 24];38(1):40–5. Available from: https://pubmed.ncbi.nlm.nih.gov/31327485/
Divakaran S, Loscalzo J. The role of nitroglycerin and other nitrogen oxides in cardiovascular therapeutics. J Am Coll Cardiol. 2017 Nov 11;70(19):2393–410.