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Elio DiSegni, MD; Elieser Kaplinsky, MD; Herman O. Klein, MD; Maurice Levy, MD

Arch Intern Med. 1978;138(9):1427-1429.

Abstract
Two patients with a ruptured interventricular septum complicating acute myocardial infarction were treated with isosorbide dinitrate. The first patient recovered from cardiogenic shock after sublingual administration of 5 mg of isosorbide dinitrate every two hours and was successfully operated on. The second patient recovered from severe pulmonary edema during the acute stage of the infarction with sublingual isosorbide dinitrate. Moreover, she experienced a considerable symptomatic improvement when a 5 mg sublingual dose of isosorbide dinitrate every three hours was added to her long-term treatment. Analysis of hemodynamic data showed that the most striking change following administration of the drug was the substantial reduction of pulmonary wedge pressure. The striking symptomatic and hemodynamic improvement was achieved by the favorable effect of afterload reduction on left ventricular performance and not by reduction in left to right shunt.

(Arch Intern Med 138:1427-1429, 1978)

Author Affiliations
From the Department of Cardiology, Meir Hospital, Kfar-Saba (Drs DiSegni, Kaplinsky, and Klein), and the Department of Thoracic Surgery, Beilinson Hospital, Petah-Tikva (Dr Levy), Tel-Aviv University Sackler School of Medicine, Tel-Aviv, Israel.

Footnotes
Accepted for publication Jan 16, 1978.

Reprint requests to Department of Cardiology, Meir Hospital, Kfar-Saba, Israel (Dr Kaplinsky).

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