Treatment of Refractory Angina Pectoris With Nitroglycerin and Graded Exercise

The treatment of 17 persons incapacitated by refractory angina pectoris was initiated during a three-week hospital program. The patients ranged in age from the mid 30's to mid 60's and included one woman and 16 men. They were unable to walk more than half a block without inducing anginal attacks. These patients required daily 15 to 25 nitroglycerin tablets taken sublingually. The program consisted of graded increments of treadmill exercise preceded by administration of nitroglycerin and with continuous cardiac monitoring. Its basis was to increase the work load of the heart during the maximal dilatory effects of nitroglycerin taken sublingually, the end result being permanent enlargement of the collateral circulation and more efficient myocardial extraction of oxygen. All 17 patients improved and none suffered further myocardial damage during or after the program, while continuing their exercises at home. Follow-up over one year has shown continued improvement in 15 patients.