Effectiveness of nebulized nitroglycerine in patients with right heart failure with severe pulmonary artery hypertension - A prospective,randomized, placebo controlled trial

This is how i enroll participants ??

Eligible participants will include adult patients (aged 18 years and older) presenting with acute onset of Shortness of breath (SOB) in a confirmed case of  right heart failure(RHF ) with severe PAH ( pulmonary artery hypertension ) will be recruited to the study. The patient will be started on O2 by a non rebreathing mask at 10-15 liters per minute. ECG will be taken to rule out acute MI as the cause of SOB. History of fever, cough with sputum will be recorded and chest will be auscultated crepitations. Bedside chest radiograph will be ordered to rule out pneumonia. Arterial blood gas sample will be obtained simultaneously and results recorded . PaO2 -FiO2 ratio will be documented to rule out ARDS. Cardiologist on call will be requested for POCUS to assess cardiac function.Following findings on POCUS suggest RHF- Right ventricle dilatation, Tricuspid regurgitation, Right ventricular free wall diastolic collapse, Mcconnels sign,abnormal TAPSE values and dilated IVC and pulmonary artery hypertension is measured by systolic pulmonary artery pressure in which

mPAP > 55mm hg indicates severe PAH .Patients included in the study will be explained about the study process and written consent will be taken. Exclusion criteria have contraindication to nitroglycerin therapy, such as allergy, recent use of phosphodiesterase inhibitors, and significant hypovolemia ( IVC diameter less than 1 cm and completely collapsing on deep inspiration).