IS NITROGLYCERIN DETRIMENTAL IN PATIENTS WITH CORONARY-ARTERY ECTASIA- A CASE-REPORT

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 s treptokinase infusion. Subsequent coronary angiography revealed diffus e ectasia with no significant stenosis. We discuss the possible pathop hysiologic 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 o f patients whose acute myocardial ischemia might be worsened by the ad ministration of nitroglycerin.