Nitroglycerin
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Paradoxical vasospastic response: case report A 65-year-old woman had paradoxical vasospastic response during treatment with nitroglycerin for recurrent syncopal episodes. The woman was admitted to the Syncope Unit for recurrent syncopal episodes of uncertain aetiology. A head up tilt test (HUTT) was carried out with continuous ECG monitoring and BP measurements every 3 minutes. Following 20 minute drug-free passive orthostatic phase, sublingual nitroglycerin 400mg spray was administered. Additionally, she received olmesartan medoxomil [olmersartan], atorvastatin and aspirin [cardioaspirin] concomitantly. Three minutes after the initiation of nitroglycerin, she experienced blurred vision, dizziness, tingling and angina without experiences syncope. The BP and heart rate were 90/55 mm Hg and 72 beats per minute, respectively. The ECG showed 2 mm ST-segment elevation (STE) in inferior leads with reciprocal ST depression in the lateral leads. Based on these findings and clinical presentation, it was concluded that she had paradoxical vasospastic response to nitroglycerin, which resulted in paradoxical ischaemia. The woman was laid in supine position and after few minutes the STE had normalised. She was admitted to the coronary care unit for evaluation of ischaemia. Before discharge, a loop recorder (ILR) was implanted. At a follow-up after 6 months, she denied further episodes of syncope and no noteworthy ECG abnormalities or arrhythmias were detected by ILR. Carbone A, et al. ST-elevation during head up tilt test: A challenging case in syncope unit. Monaldi Archives for Chest Disease 90: 281-284, No. 2, 2020. Available from: 803519219 URL: http://doi.org/10.4081/monaldi.2020.1271
0114-9954/20/1833-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 5 Dec 2020 No. 1833
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