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Nitroglycerin-induced transient coronary artery occlusion
K Takayanagi1, K Hoshi, S Kimura
1Department of Cardiology, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama, Japan.
Japanese Heart Journal
|July 1, 1991
Summary
Nitroglycerin caused a severe blockage in a patient's coronary artery to temporarily disappear during an angiogram. This paradoxical effect, observed in myocardial infarction, resolved within minutes.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Non-Q wave myocardial infarction presents unique challenges in coronary artery disease management.
- Coronary artery stenosis significantly impairs blood flow, leading to ischemic events.
Observation:
- A 57-year-old male patient with a 95% stenosis in the left anterior descending coronary artery was administered 0.3 mg sublingual nitroglycerin.
- Following nitroglycerin administration, the stenosed coronary artery segment became completely invisible on coronary angiography within 2 minutes.
Findings:
- The observed phenomenon was a paradoxical, transient occlusion of the stenosed coronary artery.
- The artery reappeared (was opacified) 3 minutes after nitroglycerin administration.
- This transient disappearance may be attributed to the passive collapse of the distal artery segment.
Implications:
- This case highlights an unusual response to nitroglycerin in severe coronary stenosis.
- Understanding such paradoxical reactions is crucial for accurate interpretation of diagnostic imaging in cardiology.
- Further research is needed to elucidate the precise mechanisms underlying this transient arterial collapse.