Key result
Sublingual nitroglycerin requires at least ~6 minutes post-absorption to relieve coronary artery spasm.
Why the study?
The time course of nitroglycerin's effect on coronary artery spasm and its impact on angiographic interpretation was not well characterized.
Does sublingual nitroglycerin relieve coronary artery spasm in a time-dependent manner during angiography?
Observational (n=4)
Does sublingual nitroglycerin relieve coronary artery spasm in a time-dependent manner during angiography?
Clinicians should wait at least six minutes after sublingual nitroglycerin administration during angiography to accurately distinguish between fixed atheromatous obstruction and localized vasospasm.
May warrant delayed angiographic assessment after nitroglycerin; hypothesis-generating in small series, needs prospective validation.
The arteriographic distinction between a fixed atheromatous obstruction and localized vasospasm in the coronary artery is often decided by the response of the lesion to nitroglycerin. We studied the time course of nitroglycerin in four patients with coronary artery spasm as revealed by selective angiography. Following complete dissolution of a 0.6 mg tablet of nitroglycerin sublingually a slight increase in heart rate occurred as early as two minutes, variable changes in overall vessel diameter were observed within four minutes, but the localized spasm remained fixed. It was not until six minutes had elasped that reinjection showed disappearance of spasm and uniform patency of the vessel in all cases. These observations stress the importance of waiting an appropriate period of time (at least six minutes) following complete absorption of sublingual nitroglycerin before any conclusion can be rationally drawn regarding the nature of a stenotic lesion as seen angiographically.
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Fallen et al. (1978) conducted an observational in Coronary artery spasm (n=4). Nitroglycerin was evaluated on Disappearance of spasm and uniform patency of the vessel. Sublingual nitroglycerin required at least six minutes following complete absorption to achieve disappearance of coronary artery spasm and uniform vessel patency in all 4 patients.
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