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Cardiac effects of nitroglycerin
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• 08/25/25
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Side Effects
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Primary Effect: Reduces myocardial oxygen demand mainly by decreasing left ventricular preload
Key Mechanisms:
Vasodilation:
- Preferentially dilates venules (low doses)
- Dilates arterioles at higher doses
- Dilates coronary arteries (both normal and post-stenotic)
Cardiovascular Effects:
- Decreases preload → Reduces LV wall stress
- Reduces afterload (secondary effect)
- Improves coronary collateral flow
- Can cause reflex tachycardia
Pharmacology:
- Onset: 1-3 minutes
- Half-life: 2-3 minutes
- Metabolism: Primarily hepatic
- Mechanism: Activates guanylyl cyclase → ↑cGMP → ↓calcium entry → smooth muscle relaxation
Clinical Considerations:
- First-line treatment for myocardial ischemia
- Contraindicated in:
- Hypovolemia
- Suspected inferior wall infarction
- Concurrent use with PDE5 inhibitors (risk of severe hypotension)
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