Nitrates in acute myocardial infarction--state of the art.

Until the 1970s, nitroglycerin was used mainly for controlling angina pectoris. It was generally avoided in the setting of acute myocardial infarction. The main reason was fear of hypotension and reflex tachycardia. Experimental and clinical data since the mid-1970s indicate that hypotension should indeed be avoided during acute infarction. More important, prolonged low-dose intravenous nitroglycerin is now regarded as safe therapy during acute infarction for improving left ventricular performance, limiting infarct size, and reducing infarct-related complications.