noelle
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1} r nitrates contraindicated in right ventricle infarction?? :?
2} how do they relieve pain of angina ... by vasodilation of coronary arteries or decrease in preload by dilatetion of capacitance vessels!! :roll: :?
ps: QS from UW.
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| zaki
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Answer
1)yes they are because they cause hypotenstion in RV infarct ant the tx of of this is fluids. and avoid nitrates
2)they casuse coronary artery vasodilation and thus increases the flow of blood to the heart. they also decreases the preload that y use in heart failiure. so by doing so they decrease the workload of heart and increase the coronary blood flow thus reduces the ischemia
hope that answer your qs
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| noelle
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so if i have to choose btw cor vasodiln. and decrease in preload what shall i choose :?
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| ELM
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I think on higher doses Nitrates also decrease afterload too.
Both CA dilatation, and decrease in afterload are nitrate's effects, if you are answering a q and you are in a dilemma i will pick dilate of CAs.
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ELM
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| noelle
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I JUST READ NITRATES R BETTER VENO.. VS ARTERIAL DILATORS.. 4TIMES MORE.. SO STILL I SHD PICK COR. ARTERY?? :?
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| mikyro
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1} r nitrates contraindicated in right ventricle infarction??
2} how do they relieve pain of angina ... by vasodilation of coronary arteries or decrease in preload by dilatetion of capacitance vessels!!
Dear Noelle,
Here's my opinion.
If infarction of the RV only (which is quite rarely encounted in clinical practice) w/o the involvement of the LF - you must not give nitrates bcuz they cause vasodilation and decrease in preload and afterload. You should instead give fluids and insert a Ganz catheter to check volume status (PCWP).
If infarction of both LV and RV (actually infarction of the RV is usually associated with infarction of the LV) - NEXT: Cardiogenic shock present?
YES: Resuscitate - NEXT: thrombolythics CI?
YES - strongly consider PTCA;
NO: give thrombolythics - if more than 3-4 hrs of the onset - consider PTCA
NO cardiogenic shock: Give thrombolythics or consider PTCA (more useful)
At any rate, do not give nitrates if infarction of RV alone or RV and LV.
Hope it helped.
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| noelle
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thanks a lot miky it really helped me 
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| jalwa
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hi i have comment regarding the nitrates action
its role in angina is all the three dec preload,dilataion of ca and dec after load
pick dec preload that releaves pain
hope tht helps
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