Hemodynamic effects of inhaled nitric oxide in right ventricular myocardial infarction and cardiogenic shock.
OBJECTIVE
We sought to determine whether or not inhaled nitric oxide (NO) could improve hemodynamic function in patients with right ventricular myocardial infarction (RVMI) and cardiogenic shock (CS).


BACKGROUND
Inhaled NO is a selective pulmonary vasodilator that can decrease right ventricular afterload.


METHODS
Thirteen patients (7 males and 6 females, age 65 +/- 3 years) presenting with electrocardiographic, echocardiographic, and hemodynamic evidence of acute inferior myocardial infarction associated with RVMI and CS were studied. After administration of supplemental oxygen (inspired oxygen fraction [F(i)O(2)] = 1.0), hemodynamic measurements were recorded before, during inhalation of NO (80 ppm at F(i)O(2) = 0.90) for 10 min, and 10 min after NO inhalation was discontinued (F(i)O(2) = 1.0).


RESULTS
Breathing NO decreased the mean right atrial pressure by 12 +/- 3%, mean pulmonary arterial pressure by 13 +/- 2%, and pulmonary vascular resistance by 36 +/- 8% (all p < 0.05). Nitric oxide inhalation increased the cardiac index by 24 +/- 11% and the stroke volume index by 23 +/- 12% (p < 0.05). The NO administration did not change systemic arterial or pulmonary capillary wedge pressures. Contrast echocardiography identified three patients with a patent foramen ovale and right-to-left shunt flow while breathing at F(i)O(2) = 1.0. Breathing NO decreased shunt flow by 56 +/- 5% (p < 0.05) and was associated with markedly improved systemic oxygen saturation.


CONCLUSIONS
Nitric oxide inhalation results in acute hemodynamic improvement when administered to patients with RVMI and CS.
Inglessis
Ignacio
I
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Shin
Jordan T
JT
Lepore
John J
JJ
Palacios
Igor F
IF
Zapol
Warren M
WM
Bloch
Kenneth D
KD
Semigran
Marc J
MJ
D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D009569:Nitric Oxide / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology
D014665:Vasodilator Agents; D009569:Nitric Oxide