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Can IV Nitro Help CHF With Acute Pulmonary Edema?

Two systems find new protocols safe and effective.

Upon completion of this course, students will be able to:

  • Examine the evidence supporting bolus IV nitroglycerin use in APE; 
  • Describe an effective and safe administration protocol for NTG; 
  • Consider the potential impact of bolus NTG treatment in the face of COVID-19.


1. Cotter G, Kaluski E, Moshkovitz Y, Milovanov O, Krakover R, Vered Z. Pulmonary edema: new insight on pathogenesis and treatment. Curr Opin Cardiol, 2001; 16: 159–63.

2. Kelly RP, Gibs HH, O’Rourke MF, Daley JE, Mang K, Morgen JJ, Avolid AP. Nitroglycerin has more favourable effects on left ventricular afterload than apparent from measurement of pressure in a peripheral artery. Eur Heart J, 1990; 11: 138–44.

3. Cotter G, Metzkor E, Kaluski E, et al. Randomised trial of high-dose isosorbide dinitrate plus low- dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet, 1998; 351: 389–93.

4. Sharon A, Shpirer I, Kaluski E, et al. High-dose intravenous isosorbide-dinitrate is safer and better than Bi-PAP ventilation combined with conventional treatment for severe pulmonary edema. J Am Coll Cardiol, 2000; 36: 832–7.

5. Levy P, Compton S, Welch R, et al. Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Ann Emerg Med, 2007; 50: 144–52.

6. Wilson SS, Kwiatkowski GM, Millis SR, Purakal JD, Mahajan AP, Levy PD. Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure. Am J Emerg Med, 2017; 35: 126–31.

7.  Patrick C, Ward B, Anderson J, Rogers Keene K, Adams E, Cash RE, Panchal AR, Dickson R. Feasibility, Effectiveness and Safety of Prehospital Intravenous Bolus Dose Nitroglycerin in Patients with Acute Pulmonary Edema. Prehosp Emerg Care, 2020 Jan 27 [epub ahead of print].

  • Format
  • Duration
    30 min.
  • Credits
    .5 CE
  • After passing the course, your certificate will be available for download here.