Nonocclusive coronary disease after chronic exposure to nitrates: evidence for physiologic nitrate dependence

A 38-year-old man, exposed to notroglycerin in his work as an explosives expert, developed non-occlusive ischemic heart disease after withdrawal of exposure to organic nitrates. Despite the severity of his symptoms and the documented spasm of his right coronary artery, his electrocardiogram was at all times normal, as were results of a wide panel of laboratory tests. Sublingual nitroglycerin amerliorated the symptoms which have decreased with time.