PREDIMAN K. SHAH, M.D.
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To the editor: Nitrates administered sublingually or intravenously generally produce prompt reduction in pulmonary capillary wedge pressure due to their venodilator effects and are thus a mainstay of the emergency management of acute pulmonary edema (1). We have recently seen three patients who remained in severe symptomatic pulmonary edema despite rapidly increasing doses of intravenous nitroglycerin, several doses of sublingual nitroglycerin, morphine, and large doses of diuretic agents but showed prompt and dramatic improvement after buccal application of half an inch of 2% nitroglycerin ointment (approximately 7.5 mg).
A 76-year-old white woman was admitted to our cardiac intensive care unit
SHAH PK. Buccal Nitroglycerin Ointment in Acute Cardiopulmonary Edema. Ann Intern Med. ;103:153–154. doi: 10.7326/0003-4819-103-1-153_2
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Published: Ann Intern Med. 1985;103(1):153-154.
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