Haemodynamic advantages of isosorbide dinitrate over frusemide in acute heart-failure following myocardial infarction

Lancet. 1983 Apr 2;1(8327):730-3. doi: 10.1016/s0140-6736(83)92025-1.


The immediate haemodynamic effects of intravenous frusemide (1 mg/kg) and intravenous isosorbide dinitrate (50-200 micrograms/kg/h) were compared in a prospective, randomised, between-group study in 28 men with radiographic and haemodynamic evidence of left ventricular failure following acute myocardial infarction. The diuresis induced by frusemide reduced the left heart filling pressure and cardiac output and transiently raised systemic blood-pressure. In contrast, isosorbide dinitrate was accompanied by a reduction in systemic blood-pressure and peripheral resistance with the result that the cardiac output was not decreased despite a large fall in the pulmonary vascular and left heart filling pressures. These results indicate that reduction of excessive preload by venodilatation may be haemodynamically superior to that induced by diuresis in terms of both reducing myocardial oxygen consumption and maintaining peripheral perfusion. The influence of these contrasting treatments on the prognosis of these high-risk patients warrants further study.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Clinical Trials as Topic
  • Furosemide / pharmacology
  • Furosemide / therapeutic use*
  • Heart Failure / drug therapy*
  • Heart Failure / etiology
  • Hemodynamics / drug effects*
  • Humans
  • Isosorbide Dinitrate / pharmacology
  • Isosorbide Dinitrate / therapeutic use*
  • Male
  • Middle Aged
  • Myocardial Infarction / complications*
  • Prospective Studies
  • Random Allocation


  • Furosemide
  • Isosorbide Dinitrate