What are nitrates, how are they used in the treatment of acute myocardial infarction (MI, heart attack), and what is the recommended dosage?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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Nitrates are potent vasodilators, and they act mainly to relax the venous system. Systemic venodilation results in reduction of venous blood return to the heart (ie, reducing the ventricular preload); this will lead to reduction of the workload of the heart, less oxygen demand, and reduction in ischemic pain. Nitrates are also the most commonly used agents to reduce cardiac chest pain related to ischemia via coronary vasodilation; however, their use is not associated with reduction in ACS-associated mortality.

Nitrates are usually given as a 0.4 mg dose in a sublingual tablet, followed by close observation of the effect on chest pain and the hemodynamic response. If the initial dose is well tolerated, further nitrates can be administered. The most common side effect of nitrates are hypotension and headache.

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