J. DOUGLAS WHITE, M.D.
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To the editor: Dr. Tillisch (1) proposes nitroprusside as the agent of choice for impedance reduction in the setting of septic shock with depressed cardiac output and substantially elevated systemic vascular resistance. This is a curious selection in the context of his cogent discussion of myocardial compromise, particularly from reduced subendocardial flow, as an important contribution to any shock syndrome. Despite its relatively long duration of action, nitroglycerin has been demonstrated by Chiariello and associates (2) to promote flow to areas of subendocardial ischemia better than nitroprusside in the setting of an acute myocardial infarction. Nitroglycerin is the drug of
WHITE JD. Nitroprusside or Nitroglycerin. Ann Intern Med. 1981;94:540–541. doi: 10.7326/0003-4819-94-4-540_2
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Published: Ann Intern Med. 1981;94(4_Part_1):540-541.
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