Coronary artery spasm after abrupt withdrawal of nitroglycerin in rabbits

Reeves, William C.; Cook, Lawrence; Wood, M. C.; Whitesell, Larry F.

doi:10.1016/0002-9149(85)90748-9

Cited by 16 publications

(9 citation statements)

References 14 publications

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“…Experiments carried out in rabbits also demonstrated coronary spasm upon discontinuation of nitroglycerin (30). The results from the present investigation differ from those earlier studies.…”

Section: Discussioncontrasting

confidence: 99%

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Intermittent Nitrate Therapy for Prior Myocardial Infarction Does Not Induce Rebound Angina nor Reduce Cardiac Events.

et al. 2000

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Objective Long-term nitrate therapy for ischemic heart disease may cause drug tolerance which diminishes its beneficial effects ; consequently, intermittent administration of nitrates is recommended. With this regimen, however, the potential occurrence of rebound angina during the nitratefree intervals is a source of concern. Subjects and MethodsWecarried out a retrospective study of 606 patients to determine whether rebound angina occurred whenconventional continuousnitrate administration was replaced by intermittent administration as part of a long-term therapy protocol for prior myocardial infarction. Thesubjects were receiving treatment for myocardial infarction and included 293 patients treated with nitrates (Nitrate group) and 313 patients who were not (Nonitrate group). The former included 186 patients who received intermittent nitrate administration (Intermittent group) and 107 patients who received continuous administration (Continuous group). The mean period of observation was 4.3+1.6 months.

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Section: Discussioncontrasting

confidence: 99%

“…One of these patients manifested the symptoms2 days after discontinuation of ISDN, and 2 patients developed coronary spasm. These results appear to be noteworthy in relation to the reports cited above (29,30).…”

Section: Discussionsupporting

confidence: 83%

Intermittent Nitrate Therapy for Prior Myocardial Infarction Does Not Induce Rebound Angina nor Reduce Cardiac Events.

et al. 2000

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“…Reflex neurohumoral activation initiated by nitrates might play a role in increasing cardiac events [18, 20, 21]. Abrupt withdrawal of nitroglycerin and subsequent administration of ergonovine and indomethacin probably induces the coronary artery spasm which causes myocardial ischemia, ventricular arrhythmia and myocardial infarction [22, 23]. …”

Section: Discussionmentioning

confidence: 99%

Chronic Use of Continuous Dosing of Long-Term Nitrates Does Not Prevent Cardiac Events in Patients with Severe Acute Myocardial Infarction

Kanamasa

Hayashi²,

Takenaka³

et al. 2000

Cardiology

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This study was performed to investigate the effects of the chronic use of continuous, not eccentric, dosing of nitrates on cardiac events in patients with severe acute myocardial infarction. A total of 1,303 patients with healed myocardial infarction were divided into two groups: treatment with nitrates or nontreatment. Primary end points were nonfatal and fatal recurrent myocardial infarction, death from congestive heart failure and sudden death. Among the 725 patients treated with nitrates, 45 patients (6.2%) experienced cardiac events during the observation period, whereas only 17 of the 578 patients treated without nitrates (2.9%) had cardiac events. This difference was statistically significant (p < 0.01; odds ratio 2.18, 95% confidence interval 1.24–3.86). In Killip class II–IV patients, the incidence of cardiac events in patients with nitrates was significantly greater than in patients without nitrates (18.8 vs. 3.5%, p < 0.05). The chronic use of continuous, not eccentric, dosing of nitrates did not prevent cardiac events in patients with severe acute myocardial infarction.

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“…When we compared the rate of change in coronary blood velocity after sublingual nitroglycerin among the 3 groups, APV in the continuous dosing group decreased by 13±6% of the pretreatment value, whereas the rates of decrease were 32±5% in the eccentric dosing group and 39±6% in the untreated group, suggesting the appearance of tolerance in the continuous dosing group. The limitations of eccentric dosing of nitrates include a rebound phenomenon related to a decrease in the blood concentration of nitrates, and this phenomenon has been experimentally and clinically reported as deterioration of anginal symptoms or coronary stenosis related to discontinuation of nitrates (18)(19)(20)(21). Eccentric dosing does not prevent cardiac events (22)(23)(24).…”

Section: Tolerance To Nitratesmentioning

confidence: 99%

Inhibition of Nitrate Tolerance without Reducing Vascular Response during Eccentric Dosing of Nitrates

et al. 2006

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It has been reported that the nitrate tolerance related to continuous dosing of nitrates reduces drug efficacy, and therefore eccentric dosing of nitrates is recommended. In this study, we investigated the appearance of nitrate tolerance related to continuous dosing of nitrates and prevention of nitrate tolerance during eccentric dosing by comparing the grade of coronary dilatation after sublingual nitroglycerin. Of 26 patients with ischemic heart disease who underwent elective cardiac catheterization, 8 patients were continuously administered nitrates, 8 patients were eccentrically administered nitrates, and 10 patients were not treated. We compared the coronary response to sublingual nitroglycerin among the 3 groups. In a coronary vessel without significant stenosis, the coronary vessel area, coronary lumen area, and mean coronary blood flow velocity after sublingual nitroglycerin were measured using intravascular ultrasound (IVUS). In the continuous dosing group, the maximal rate of change in the vessel area after sublingual nitroglycerin was 105 ± 1

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Coronary artery spasm after abrupt withdrawal of nitroglycerin in rabbits

Cited by 16 publications

References 14 publications

Intermittent Nitrate Therapy for Prior Myocardial Infarction Does Not Induce Rebound Angina nor Reduce Cardiac Events.

Intermittent Nitrate Therapy for Prior Myocardial Infarction Does Not Induce Rebound Angina nor Reduce Cardiac Events.

Chronic Use of Continuous Dosing of Long-Term Nitrates Does Not Prevent Cardiac Events in Patients with Severe Acute Myocardial Infarction

Inhibition of Nitrate Tolerance without Reducing Vascular Response during Eccentric Dosing of Nitrates

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