Nitroprusside in Acute Congestive Heart Failure

To the Editor: I wonder how many cardiologists with even limited clinical experience will agree with Cohn and Franciosa, in their recommendations on vasodilator therapy of acute pulmonary edema (N Engl J Med 297:27–31, 254–258, 1977). In their statement of the problem, they indicate that the dominant features clinically are “extreme dyspnea, orthopnea and anxiety.” They then go on to develop the hemodynamic basis for this opinion and conclude, as scientifically oriented investigators probably should, that the treatment is aimed at promptly reducing pulmonary-capillary pressure. I should have thought that the immediate treatment would be the relief of the patient's.