Brief report
The paradox of nitrates in patients with angina pectoris and angiographically normal coronary arteries

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Abstract

Patients with angina pectoris found to have angiographically normal coronary arteries and no evidence of coronary spasm or ventricular hypertrophy present a management dilemma to all physicians. Most of these patients have an inadequate vasodilatory capacity of the coronary microcirculation,1 which may result in ischemia during increases in myocardial oxygen demand; accordingly, they could benefit from either vasodilator agents or drugs that reduce myocardial oxygen demand. Nitrates are among the oldest, effective antianginal pharmacologic agents; their mechanisms of action are capable of affecting both the supply and demand side of the metabolic equation of the heart,2 which appeared promising in regard to treatment of this syndrome. Therefore, the present study was performed to investigate the effects of isosorbide dinitrate on coronary hemodynamics and anginal threshold in a group of patients with the aforementioned set of findings, as well as reversible thallium abnormalities during exercise.

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Dr. Bugiardini's current address is: Istituto di Patologia Medica III, Policlinico S. Orsola, Via Massarenti, 9, 40138, Bologna, Italy.

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