Intravenous isosorbide dinitrate in acute left ventricular failure--a dose--response study.

The haemodynamic effects of intravenous isosorbide dinitrate (Cedocard) in patients with severe acute left ventricular failure have been assessed using incremental infusion rates from 50 to 800 micrograms min-1. For most patients most of the fall in pulmonary arterial diastolic pressure occurred by 200 micrograms min-1, with little further fall at higher doses. At 200 micrograms min-1 pulmonary arterial diastolic pressure fell from 29 to 23 mgHg (P less than 0.001), there was no significant change in cardiac index (1.9 to 2.0 L min-1 m-2) or heart rate (108 to 108 beats min-1). Despite high doses, no side effects were observed. Intravenous isosorbide dinitrate is effective and safe in the management of acute severe left ventricular failure. In most patients an infusion rate of about 200 micrograms min-1 produces optimal haemodynamic effects.