Nitrate Tolerance as a Possible Cause of Multidrug-Resistant Coronary Artery Spasm A Case Report and Its Implications

Coronary spasm can usually be controlled by administration of Ca antagonists. However, there are some cases of coronary spasm whose attacks cannot be controlled even with large doses of Ca antagonist and/or its combination with nitrates. Here we describe the case of a 41-year-old man whose attacks o...

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Published inInternational Heart Journal Vol. 51; no. 3; pp. 211 - 213
Main Authors Morikawa, Yoshinobu, Mizuno, Yuji, Harada, Eisaku, Kuboyama, Osamu, Yoshimura, Michihiro, Yasue, Hirofumi
Format Journal Article
LanguageEnglish
Published International Heart Journal Association 2010
Subjects
Alcohol
Aldehyde dehydrogenase 2
Coronary spasm
Nitrate tolerance
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Abstract Coronary spasm can usually be controlled by administration of Ca antagonists. However, there are some cases of coronary spasm whose attacks cannot be controlled even with large doses of Ca antagonist and/or its combination with nitrates. Here we describe the case of a 41-year-old man whose attacks of coronary spasm were resistant to the combined administration of nitrates, Ca antagonists, and a statin. The attacks were alleviated and disappeared after withdrawal of nitrates and recurred after readministration of a nitroglycerin patch. The involvement of nitrate tolerance in the pathogenesis of multidrug resistant coronary spasm was revealed and its implication discussed.
AbstractList Coronary spasm can usually be controlled by administration of Ca antagonists. However, there are some cases of coronary spasm whose attacks cannot be controlled even with large doses of Ca antagonist and/or its combination with nitrates. Here we describe the case of a 41-year-old man whose attacks of coronary spasm were resistant to the combined administration of nitrates, Ca antagonists, and a statin. The attacks were alleviated and disappeared after withdrawal of nitrates and recurred after readministration of a nitroglycerin patch. The involvement of nitrate tolerance in the pathogenesis of multidrug resistant coronary spasm was revealed and its implication discussed.
Author Harada, Eisaku
Morikawa, Yoshinobu
Kuboyama, Osamu
Yasue, Hirofumi
Mizuno, Yuji
Yoshimura, Michihiro
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  fullname: Yasue, Hirofumi
  organization: Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute
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SubjectTerms Alcohol
Aldehyde dehydrogenase 2
Coronary spasm
Nitrate tolerance
Subtitle A Case Report and Its Implications
Title Nitrate Tolerance as a Possible Cause of Multidrug-Resistant Coronary Artery Spasm
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