From the Research
Nitroglycerin should be stopped immediately in patients with obstructive pulmonary artery disease as it can cause dangerous hypotension and worsen right ventricular function. This medication is generally contraindicated in this condition because it causes vasodilation, which can reduce pulmonary vascular resistance but also significantly decreases systemic vascular resistance. In obstructive pulmonary artery disease, the right ventricle is already struggling against increased afterload, and the drop in systemic pressure from nitroglycerin can critically reduce coronary perfusion to the stressed right ventricle.
Some studies have investigated the use of nitric oxide and other vasodilators in pulmonary hypertension, such as the study by 1, which found that inhaled nitric oxide can selectively dilate pulmonary vasculature in adult patients with pulmonary hypertension. However, the use of nitroglycerin is not recommended due to its systemic effects.
Alternative treatments that specifically address the underlying pulmonary obstruction should be pursued instead, such as anticoagulation for pulmonary embolism or specific pulmonary vasodilators for pulmonary hypertension that don't cause systemic hypotension to the same degree, as discussed in the study by 2. The study by 3 also highlights the importance of careful management of patients with pulmonary disease, and the potential benefits of alternative treatments.
If a patient with known or suspected pulmonary artery obstruction has been inadvertently given nitroglycerin and develops hypotension, the medication should be discontinued immediately, intravenous fluids should be administered to maintain blood pressure, and vasopressors may be required in severe cases. The study by 4 found that the combination of inhaled nitric oxide and a phosphodiesterase inhibitor may enhance and prolong the response to inhaled nitric oxide in adult patients with secondary valve-related pulmonary hypertension undergoing cardiac surgery.
In summary, the key consideration is to prioritize the patient's safety and avoid using medications that can worsen their condition, as supported by the study by 5. The most important thing is to stop nitroglycerin immediately and pursue alternative treatments that are safer and more effective for patients with obstructive pulmonary artery disease.