Nitroglycerin: Should We Still Ask?
Authors: Raymond J. Gibbons
Journal: Annals of Internal Medicine (2003)

Editorials16 December 2003Nitroglycerin: Should We Still Ask?Raymond J. Gibbons, MDRaymond J. Gibbons, MDFrom Mayo Clinic/Mayo Foundation; Rochester, MN 55905.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-139-12-200312160-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinicians have long used the response to sublingual nitroglycerin for diagnostic and prognostic purposes in a variety of settings. In stable outpatients with chest pain, pain relief by nitroglycerin has been 1 of 3 components of the most commonly used definition of typical angina (1, 2). In acutely ill patients who present to the hospital, relief of chest pain at rest with nitroglycerin has been assumed to indicate a cardiac cause of the pain. In acutely ill patients with ongoing myocardial ischemia, failure of chest pain to respond to sublingual nitroglycerin is believed to indicate a more severe problem with ...References1. Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary artery disease. N Engl J Med. 1979;300:1350-8. [PMID: 440357] CrossrefMedlineGoogle Scholar2. Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, . ACC/AHA 2002 guideline update for the management of patients with chronic stable anginasummary article: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on the Management of Patients with Chronic Stable Angina). J Am Coll Cardiol. 2003;41:159-68. [PMID: 12570960] MedlineGoogle Scholar3. Henrikson CA, Howell EE, Bush DE, Miles JS, Meininger GR, Friedlander T, . Chest pain relief by nitroglycerin does not predict active coronary artery disease. Ann Intern Med. 2003;139:979-86. LinkGoogle Scholar4. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, . ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). J Am Coll Cardiol. 2000;36:970-1062. [PMID: 10987629] MedlineGoogle Scholar5. Pryor DB, Harrell FE, Lee KL, Califf RM, Rosati RA. Estimating the likelihood of significant coronary artery disease. Am J Med. 1983;75:771-80. [PMID: 6638047] CrossrefMedlineGoogle Scholar6. Sox HC, Hickam DH, Marton KI, Moses L, Skeff KM, Sox CH, . Using the patient's history to estimate the probability of coronary artery disease: a comparison of primary care and referral practices. Am J Med. 1990;89:7-14. [PMID: 2242131] CrossrefMedlineGoogle Scholar7. Pryor DB, Shaw L, McCants CB, Lee KL, Mark DB, Harrell FE, . Value of the history and physical in identifying patients at increased risk for coronary artery disease. Ann Intern Med. 1993;118:81-90. [PMID: 8416322] LinkGoogle Scholar8. Williams SV, Fihn SD, Gibbons RJ; American College of Cardiology, American Heart Association, American College of PhysiciansAmerican Society of Internal Medicine. Guidelines for the management of patients with chronic stable angina: diagnosis and risk stratification. Ann Intern Med. 2001;135:530-47. [PMID: 11578158] LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Raymond J. Gibbons, MDAffiliations: From Mayo Clinic/Mayo Foundation; Rochester, MN 55905.Corresponding Author: Raymond J. Gibbons, MD, Mayo Clinic, 200 First Street SW, Gonda 5-412, Rochester, MN 55905. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoChest Pain Relief by Nitroglycerin Does Not Predict Active Coronary Artery Disease Charles A. Henrikson , Eric E. Howell , David E. Bush , J. Shawn Miles , Glenn R. Meininger , Tracy Friedlander , Andrew C. Bushnell , and Nisha Chandra-Strobos Metrics Cited byComparison of Frequency of Inducible Myocardial Ischemia in Patients Presenting to Emergency Department With Typical Versus Atypical or Nonanginal Chest PainPresentation of AMI—Symptoms, Examination, Biomarkers and Atypical Presentations 16 December 2003Volume 139, Issue 12Page: 1036-1037KeywordsAnginaAngiographyCoronary arteriesExerciseIschemiaNitratesOutpatientsSpecificityStable coronary artery diseaseStenosis ePublished: 16 December 2003 Issue Published: 16 December 2003 Copyright & PermissionsCopyright © 2003 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...