Is nitroglycerin detrimental in patients with coronary artery ectasia? A case report.

During the management of acute myocardial infarction, we observed that clinical and electrocardiographic indications of myocardial ischemia worsened upon nitroglycerin infusion and were promptly relieved upon streptokinase infusion. Subsequent coronary angiography revealed diffuse ectasia with no significant stenosis. We discuss the possible pathophysiologic mechanisms by which nitroglycerin might exacerbate ischemia in patients with non-stenotic ectasia, and we present supporting data from other sources. We also attempt to identify the characteristics of patients whose acute myocardial ischemia might be worsened by the administration of nitroglycerin.