High-dose nitroglycerin boluses may prevent endotracheal intubation and ICU admission in patients with acute hypertensive heart failure.
Protocols of dose recommendation: 1. Inclusion: SBP > or = 160 mmHg or MAP > or = 120 mm Hg, who failed to response to initial O2, sublingual NTG x 3, and furosemide. 2. Dosage: 2mg of NTG IV boluses slowly in increments q3-5min, up to a total of 10 doses.
Contraindications of NTG in lung edema or AHF: 1. Severe aortic stenosis (AS). 2. HOCM or LVOT obstruction with SAM (systolic anterior motion of the mitral valve). 3. Recent use of Viagra or Cialis.