PubMed · 425054
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M Allgöwer. 1979. [Shock].. https://pubmed.ncbi.nlm.nih.gov/425054/
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Nitrates exert both hemodynamic and nonhemodynamic effects that help explain the mechanisms by which these drugs benefit patients with myocardial ischemia. The hemodynamic effects of nitrates include relaxation of conduit arteries, increased arterial compliance, increased venous capacitance, dilation of collateral vessels in the myocardium, and, possibly, increased myocardial compliance. A growing body of evidence suggests that the nonhemodynamic effects of these agents include inhibition of vascular smooth muscle growth and of myocyte hypertrophy and ventricular remodeling. Since endothelial function appears to be abnormal in patients with myocardial ischemia and nitrates replicate many of the effects of endothelium-derived relaxing factor, these drugs may be viewed as a pharmacologic replacement for deficient endogenous activity.
The beneficial effects of nitrates in patients with angina pectoris and acute myocardial infarction have positively influenced the prognosis of the treated patients. Studies of Jugdutt pointed out that there is a better prognosis also in the postinfarction period. Especially left ventricular over dilatation, which follows larger infarct, can be prevented by a consistent nitrate therapy.
Septic shock is an acute impairment of tissue perfusion, characterized by hypotension, low systemic vascular resistance and increased blood levels of lactate. Myocardial dysfunction is common despite hyperdynamic circulation, and may limit the patient's ability to respond to increased tissue oxygen demand. The treatment of hypotension necessitates the use of sympathomimetic drugs, which may compromise regional tissue perfusion despite overall stabilization of hemodynamics. The disproportionately high splanchnic oxygen demand in sepsis makes the splanchnic region susceptible to tissue hypoxia, which may contribute to the development of multiple organ failure in septic shock. Since the changes in regional oxygen transport do not necessarily parallel changes in systemic oxygen transport, the effects of vasoactive drugs on regional blood flow in sepsis should be studied in more detail.