Evidence-based use of nitro?

[aussiephil]

Nitro only delays the inevitable, nitro is NOT the fix for MIs, A STENT IS! Google studies on stents, you might find what you are looking for.

Ummm,

there is now studies underway to determine if stenting really is all it is cracked up to be & early reports are that in most cases may prove unnecesarry.

Try again.

[ERDoc]

AZCEP, do you have the journals and years that those studies were published. I admit, I'm too lazy to look for it myself right now.

[AZCEP]

Actually, I got them from our friend Google. Using "NTG for AMI" as the search term.

[BEorP]

Nitro helps vasodilate coronary arteries, which in return, supples the heart muscle with oxygen which helps lessen damage to the heart muscle. I might be wrong but how could this not help the heart during a AMI. This is why we use MONA. We try at every angle to help the heart muscle til a stent or what ever needs to be done.

I don't have anything to link to to back this up and don't have time to search for more info right now, but I believe I have read somewhere that nitro for AMI will not usually actually dilate coronary arteries due to plaque build up.

[AZCEP]

Check the articles I referenced. One of them seems to mention that NTG CAN cause ischemic tissue to receive less perfusion.

[logos]

I don't have anything to link to to back this up and don't have time to search for more info right now, but I believe I have read somewhere that nitro for AMI will not usually actually dilate coronary arteries due to plaque build up.

Yes. The effect of nitroglycerin is largely due to its capacity to dilate the body's large vein ("compliance vessels"). This causes decreased venous return to the heart and thus decreased myocardial oxyen demand. If coronary vasodilation plays any role at all, it is small.

This makes sense as one would expect ischemic coronary arteries to already be maximally dilated by their own production of vasodilatory metabolites (CO2, adenosine). In fact, in this system, one might even expect nitrates to cause dilation of vessels proximal to the blocked vessel, causing decreased flow to the ischemic area (the cardiac steal phenomenon).

[firefighter523]

ER Doc,

You must be a resident still. For one, any experienced doc would not waist his time picking fights, and two. If you aren't aware, nitro is the first round drug for chest pain. If you are having an MI, you are not rushed to a cath lab for nitro therapy, you will recieve therapy to UNCLOG your coronarys, USUALLY a STENT.

My evidence to support the statement is? You are funny!

[FUBAR]

Wow...................... we medics will fight over the dumbest things.

[Dustdevil]

Dude, AZCEP was the one who royally pwn3d your arse, not ERDoc. Yet.

All ERDoc did was ask you a question, which you obviously lack the ability to answer.

[ERDoc]

ER Doc,

You must be a resident still. For one, any experienced doc would not waist his time picking fights, and two. If you aren't aware, nitro is the first round drug for chest pain. If you are having an MI, you are not rushed to a cath lab for nitro therapy, you will recieve therapy to UNCLOG your coronarys, USUALLY a STENT.

My evidence to support the statement is? You are funny!

Insults are the weapon of the weak, incompetent and uneducated. Once again, you have shown your true colors. My residency days are long behind me. I was not picking a fight, but your insecurity may have taken it that way and I am sorry you feel that way. An experienced doc would question someone making such a blanket statement to provide the evidence to backup their arguement, which is exactly what I did. It appears from your comments that you need a little education in cardiology. Not all MIs are rushed to the cath lab. STEMIs are the ones that every gets all hot and bothered over. They are the ones that get rushed for a cath as soon as they walk in the door. NSTEMIs do not always end up with stents. Some are treated with medical therapy, some just receive angioplasty. I'm assuming that in your vast experience (which I have to assume since you have NEVER bothered to answer anyone's question about your experience) you have seen a pt or two who have had MIs and not been stented. As others have said, there is current literature which has been saying that we are stenting people too quickly in angina and NSTEMI. There are also other causes of MI such as coronary vasospams, Prinzmetal angina, etc. They people generally are not stented. Sometimes the vessels can be too clogged for a stent and people end up having CABGs. As I have told you in the past, study and read up on a topic before you shoot your mouth off with incorrect information.