Letter to the EditorEffectiveness of intravenous administration of nicorandil in a patient with variant angina refractory to continuous intravenous nitroglycerin
Introduction
Even though calcium blockers and nitrates are drugs of choice for treatment of patients with variant angina, there have been cases of refractory variant angina resistant to optimal standard therapy. Current treatment options for refractory variant angina include higher doses of drugs, combinations of drugs, alternative agents, or invasive treatment such as coronary artery stent placement or brachytherapy. However, adverse effects such as hypotension may lead to interruption or cessation of treatment with higher doses or different combinations of drugs. We describe a patient who had refractory variant angina with hypotensive condition to continuous intravenous infusion of nitroglycerin, which was eventually treated solely by intravenous administration of nicorandil without conventional treatment.
Section snippets
Case report
A 69-year-old man was admitted to emergency room because of severe chest pain refractory to sublingual nitroglycerin. Two months ago, he underwent coronary angiography and was diagnosed with variant angina by intracoronary ergonovine provocation test. He had been treated with diltiazem 60 mg/day and isosorbide mononitrate 40 mg/day. For two months before admission, his compliance with his medication regimen had been good and he had never experienced severe chest pain early in the morning.
On
Discussion
Refractory variant angina is a term to describe patients who are highly symptomatic due to coronary artery spasm and resistant to optimal medical therapy. In most patients with variant angina, the treatment with calcium blockers and nitrates alone or in combination therapy has been effective in preventing anginal attacks. However, 5% to 30% of patients with variant angina are refractory to full medical treatment with calcium blockers and nitrates [1]. In general, patients with refractory
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