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

Yoshinobu Morikawa; Yuji Mizuno; Eisaku Harada; Osamu Kuboyama; Michihiro Yoshimura; Hirofumi Yasue

doi:10.1536/ihj.51.211

Case Reports

Nitrate Tolerance as a Possible Cause of Multidrug-Resistant Coronary Artery Spasm

A Case Report and Its Implications

Yoshinobu Morikawa, Yuji Mizuno, Eisaku Harada, Osamu Kuboyama, Michihiro Yoshimura, Hirofumi Yasue

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Keywords: Alcohol, Aldehyde dehydrogenase 2, Coronary spasm, Nitrate tolerance

JOURNAL FREE ACCESS

2010 Volume 51 Issue 3 Pages 211-213

DOI https://doi.org/10.1536/ihj.51.211

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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.

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