Changes in heart rate under the influence of nitroglycerin in patients with stable angina pectoris of functional classes III and IV in combination with hypertension
- Authors: Safronova E.A.1, Ryabova l.V.1, Kharlamova U.V.1, Grigoricheva E.A.1, Tantsyreva I.V.1
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Affiliations:
- South Ural State Medical University
- Issue: Vol 104, No 4 (2023)
- Pages: 485-490
- Section: Theoretical and clinical medicine
- URL: https://kazanmedjournal.ru/kazanmedj/article/view/101214
- DOI: https://doi.org/10.17816/KMJ101214
- ID: 101214
Cite item
Abstract
Background. For many years, nitroglycerin has been the primary treatment for coronary pain in patients with angina pectoris, but its effect on heart rate is not fully understood.
Aim. To study the change in heart rate under the influence of nitroglycerin in patients with stable angina pectoris of functional classes III and IV in combination with hypertension.
Material and methods. The study included 122 men aged 40 to 65 years (mean age 58.42±5.8 years) with stable exertional angina of functional classes III and IV in combination with hypertension. A rhythmocardiographic study was performed with simultaneous recording of an electrocardiogram initially and 5 minutes after sublingual administration of nitroglycerin. The number of ventricular and supraventricular extrasystoles was assessed in each vegetative test (background, Valsalva, Ashner, active orthostatic and with physical activity) initially and after taking nitroglycerin. To evaluate the compared values, the mean value, standard error of the mean, maximum, minimum, frequencies, Wilcoxon criteria, Pearson's χ2 were calculated.
Results. Under the influence of sublingual intake of nitroglycerin, the number of supraventricular extrasystoles decreased in approximately 7% of patients in the background sample, in the rest, an increase prevailed in 7.4–9.0% of patients, depending on vegetative test. At the same time, the number of ventricular extrasystoles decreased in the background (in 13.9% of patients) and orthostatic (in 9.8%) samples, in the rest, their growth prevailed in 9–17% of patients, depending on vegetative test.
Conclusion. Sublingual use of nitroglycerin leads to an increase in the number of supraventricular extrasystoles, as well as a variable effect on ventricular extrasystoles, depending on the vegetative test performed.
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About the authors
Eleonora A. Safronova
South Ural State Medical University
Author for correspondence.
Email: safronovaeleonora68@gmail.com
ORCID iD: 0000-0003-1682-2028
M.D., Cand. Sci. (Med.), Assoc. Prof., Depart. of Polyclinic Therapy and Clinical Pharmacology
Russian Federation, Chelyabinsk, Russialiana V. Ryabova
South Ural State Medical University
Email: lianarabowa@rambler.ru
ORCID iD: 0000-0001-5367-2001
M.D., D. Sci. (Med.), Prof., Depart. of Life Safety, Disaster Medicine, Emergency Medicine
Russian Federation, Chelyabinsk, RussiaUliana V. Kharlamova
South Ural State Medical University
Email: top120@yandex.ru
ORCID iD: 0000-0003-2421-5797
M.D., Sci. (Med.), Prof., Depart. of Life Safety, Disaster Medicine, Emergency Medicine
Russian Federation, Chelyabinsk, RussiaElena A. Grigoricheva
South Ural State Medical University
Email: lenaqriq@rambler.ru
ORCID iD: 0000-0003-1843-5312
M.D., Sci. (Med.), Prof., Depart. of Polyclinic Therapy and Clinical Pharmacology
Russian Federation, Chelyabinsk, RussiaIrina V. Tantsyreva
South Ural State Medical University
Email: tantsyrevaiv@mail.ru
ORCID iD: 0000-0002-3090-644X
M.D., Sci. (Med.), Prof., Depart. of Polyclinic Therapy and Clinical Pharmacology
Russian Federation, Chelyabinsk, RussiaReferences
- Queiroz TM, Mendes-Júnior LG, Guimarães DD, França-Silva MS, Nalivaiko E, Braga VA. Cardiorespiratory effects induced by 2-nitrate-1,3-dibuthoxypropan are reduced by nitric oxide scavenger in rats. Auton Neurosci. 2014;181:31–36. doi: 10.1016/j.autneu.2013.12.012.
- Keller GA, Alvarez PA, Ponte ML, Belloso WH, Bagnes C, Sparanochia C, Gonzalez CD, Villa Etchegoyen MC, Diez RA, Di Girolamo G. Drug-induced QTc interval prolongation: A multicenter study to detect drugs and clinical factors involved in every day practice. Curr Drug Saf. 2016;11(1):86–98. doi: 10.2174/1574886311207040262.
- Shah SP, Waxman S. Two cases of Bezold–Jarisch reflex induced by intra-arterial nitroglycerin in critical left main coronary artery stenosis. Tex Heart Inst J. 2013;40(4):484–486. PMID: 24082386.
- Zhabina ES, Tulintseva TE, Ryngach EA, Treshkur TV. Ventricular arrhythmias induced by exercise. Vestnik aritmologii. 2017;(87):49–54. (In Russ.)
- ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407–477. doi: 10.1093/eurheartj/ehz425.
- Natsional'nye rekomendatsii po opredeleniyu riska i profilaktike vnezapnoy serdechnoy smerti. 2-e izdanie. (National guidelines for risk assessment and prevention of sudden cardiac death. 2nd edition.) M.: Medpraktika-M; 2018. 246 p. (In Russ.)
- National recommendations about diagnostics and treatment of stable stenocardia. Cardiovascular therapy and prevention. 2008;7(6 S4):1–40. (In Russ.)
- Diagnosis and treatment of arterial hypertension. Russian recommendations. Systemic hypertension. 2010;(3):5–26. (In Russ.) doi: 10.26442/SG28874.
- Mironova TF, Mironov VA. Variabel'nost' serdechnogo ritma pri ishemicheskoy bolezni serdtsa. (Heart rate variability in coronary heart disease.) Chelyabinsk: Rekpol; 2008. 136 p. (In Russ.)
- Safronova EA, Kuzin AI, Kharlamova UV, Shamaeva TN, Ryabova LV. The effect of nitroglycerin on extrasystole and heart rate variability in patients with stable angina pectoris of the 1st and 2nd functional classes. Kazan Medical Journal. 2020;101(5):645–651. (In Russ.) doi: 10.17816/KMJ2020-645.
- Lascano EC, Valle HF, Negroni JA. Nitroglycerin induces late preconditioning against arrhythmias but not stunning in conscious sheep. Scand Cardiovasc J. 2007;41(3):160–166. doi: 10.1080/14017430701329295.
- Sovari AA, Cesario D, Kocheril AG, Brugada R. Multiple episodes of ventricular tachycardia induced by silent coronary vasospasm. J Interv Card Electrophysiol. 2008;21(3):223–226. doi: 10.1007/s10840-008-9207-4.
- Yajima K, Yamase Y, Oishi H, Ikehara N, Asai Y. Coronary artery spasm during cryoballoon ablation in a patient with atrial fibrillation. Intern Med. 2018;57(6):819–822. doi: 10.2169/internalmedicine.9305-17.
- Metelitsa VI. Spravochnik po klinicheskoy farmakologii serdechno-sosudistykh lekarstvennykh sredstv. (Handbook of clinical pharmacology of cardiovascular drugs.) 2nd ed., revised. and extra. M.: BINOM; St. Petersburg: Nevsky dialect; 2002. 926 p. (In Russ.)
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