Skip to main content
NCBI home page
The Texas Heart Institute Journal logoLink to The Texas Heart Institute Journal
. 1998;25(2):140–144.

Is nitroglycerin detrimental in patients with coronary artery ectasia? A case report.

S Sanyal 1, N Caccavo 1
PMCID: PMC325527  PMID: 9654660

Abstract

During the management of acute myocardial infarction, we observed that clinical and electrocardiographic indications of myocardial ischemia worsened upon nitroglycerin infusion and were promptly relieved upon streptokinase infusion. Subsequent coronary angiography revealed diffuse ectasia with no significant stenosis. We discuss the possible pathophysiologic mechanisms by which nitroglycerin might exacerbate ischemia in patients with non-stenotic ectasia, and we present supporting data from other sources. We also attempt to identify the characteristics of patients whose acute myocardial ischemia might be worsened by the administration of nitroglycerin.

Full text

PDF
140

Images in this article

141Image
on p.141
141Image
on p.141
142Image
on p.142

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Azancot I., Masquet C., Didi D., Slama R., Bouvrain Y. Effets de l'administration parentérale de la trinitroglycérine sur la fonction myocardique, le débit coronaire et la consommation d'oxygène myocardique chez le coronarien. Nouv Presse Med. 1979 Jan 23;8(4):250–256. [PubMed] [Google Scholar]
  2. BRACHFELD N., BOZER J., GORIN R. Action of nitroglycerin on the coronary circulation in normal and in mild cardiac subjects. Circulation. 1959 May;19(5):697–704. doi: 10.1161/01.cir.19.5.697. [DOI] [PubMed] [Google Scholar]
  3. Chen L. Y., Mehta P., Mehta J. L. Platelet inhibitory effect of nitroglycerin in platelet-rich plasma: relevance of glutathione-s-transferases in plasma. J Investig Med. 1996 Dec;44(9):561–565. [PubMed] [Google Scholar]
  4. Krüger D., Stierle U., Potratz J., Diederich K. W., Sheikhzadeh A. Untersuchungen zum Nachweis einer belastungsinduzierten Myokardischämie bei isolierten Koronarektasien und -aneurysmen ("dilatative Koronaropathie"). Z Kardiol. 1996 Jun;85(6):407–417. [PubMed] [Google Scholar]
  5. Lockwood T. D. Opposing actions of cholinergic agonist and trinitroglycerin on net vascular resistance in perfused rat heart. Int J Cardiol. 1996 Nov 15;57(1):9–19. doi: 10.1016/s0167-5273(96)02775-1. [DOI] [PubMed] [Google Scholar]
  6. MARCHETTI G. V., MERLO L., ANTOGNETTI R. M. THE EFFECTS OF NITROGLYCERIN ON THE CORONARY BLOOD FLOW AND OXYGEN CONSUMPTION OF THE MYOCARDIUM IN ANESTHETIZED DOGS. Am J Cardiol. 1964 Jan;13:51–57. doi: 10.1016/0002-9149(64)90222-x. [DOI] [PubMed] [Google Scholar]
  7. Markis J. E., Joffe C. D., Cohn P. F., Feen D. J., Herman M. V., Gorlin R. Clinical significance of coronary arterial ectasia. Am J Cardiol. 1976 Feb;37(2):217–222. doi: 10.1016/0002-9149(76)90315-5. [DOI] [PubMed] [Google Scholar]
  8. Quyyumi A. A., Dakak N., Andrews N. P., Husain S., Arora S., Gilligan D. M., Panza J. A., Cannon R. O., 3rd Nitric oxide activity in the human coronary circulation. Impact of risk factors for coronary atherosclerosis. J Clin Invest. 1995 Apr;95(4):1747–1755. doi: 10.1172/JCI117852. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Rab S. T., Smith D. W., Alimurung B. N., Rab R., King S. B., 3rd Thrombolytic therapy in coronary ectasia and acute myocardial infarction. Am Heart J. 1990 Apr;119(4):955–957. doi: 10.1016/s0002-8703(05)80338-2. [DOI] [PubMed] [Google Scholar]
  10. Rath S., Har-Zahav Y., Battler A., Agranat O., Rotstein Z., Rabinowitz B., Neufeld H. N. Fate of nonobstructive aneurysmatic coronary artery disease: angiographic and clinical follow-up report. Am Heart J. 1985 Apr;109(4):785–791. doi: 10.1016/0002-8703(85)90639-8. [DOI] [PubMed] [Google Scholar]
  11. Sorrell V. L., Davis M. J., Bove A. A. Origins of coronary artery ectasia. Lancet. 1996 Jan 20;347(8995):136–137. doi: 10.1016/s0140-6736(96)90335-9. [DOI] [PubMed] [Google Scholar]
  12. Swaye P. S., Fisher L. D., Litwin P., Vignola P. A., Judkins M. P., Kemp H. G., Mudd J. G., Gosselin A. J. Aneurysmal coronary artery disease. Circulation. 1983 Jan;67(1):134–138. doi: 10.1161/01.cir.67.1.134. [DOI] [PubMed] [Google Scholar]
  13. Theron H. D., Kleynhans P. H., Marx J. D., Marks D. S. Successful coronary reperfusion with intracoronary streptokinase in a patient with coronary ectasia. S Afr Med J. 1987 Oct 3;72(7):502–503. [PubMed] [Google Scholar]
  14. Vatner S. F. Regulation of coronary resistance vessels and large coronary arteries. Am J Cardiol. 1985 Sep 18;56(9):16E–22E. doi: 10.1016/0002-9149(85)91171-3. [DOI] [PubMed] [Google Scholar]
  15. Wald R. W., Sternberg L., Feiglin D. H., Morch J. E. Effect of intracoronary glyceryl trinitrate on perfusion distribution in the collateralised human myocardium. Br Heart J. 1980 Aug;44(2):175–178. doi: 10.1136/hrt.44.2.175. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute

RESOURCES