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Intracoronary administration of isosorbide dinitrate induced severely slow flow and transient ST-segment elevation

Kazuhito Yamashita1, Hiromi Tasaki

  • 1Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan. wajinn@med.uoeh-u.ac.jp

Angiology
|April 5, 2008
PubMed

Insights

Nitroglycerin is ineffective for angina in patients with syndrome X due to microvessel dysfunction. Isosorbide dinitrate caused coronary slow flow, suggesting impaired microvascular function in heart failure patients.

Area of Science:

  • Cardiology
  • Pharmacology
  • Vascular Biology

Background:

  • Nitroglycerin is a primary treatment for angina.
  • Syndrome X and congestive heart failure can involve microvessel dysfunction.
  • Microvascular impairment affects drug efficacy.

Observation:

  • A patient with congestive heart failure experienced severe coronary slow flow and ST-segment elevation after intracoronary isosorbide dinitrate administration.
  • Coronary angiograms were normal prior to the drug challenge.
  • The patient reported mild chest pain during the event.

Findings:

  • Intracoronary isosorbide dinitrate induced significant coronary slow flow in a patient with heart failure.
  • This response suggests a delay in microvessel dilatation (less than 100 micrometers) due to dysfunction.
  • Functional stenosis may occur in microvasculature with impaired function.

Implications:

  • Microvascular dysfunction can lead to paradoxical reactions to nitrates.
  • This finding highlights the importance of assessing microvascular function in heart failure.
  • Current angina treatments may be ineffective in patients with underlying microvascular disease.

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