Nitro tolerance

Hope this gets answered by Cleveland Doctor male age 34! I like your responses. What is your opinion on the subject of nitro tolerance?  

[Cleveland Clinic]

Well, it is a real phenomenon which is caused by the body's metabolism of NTG and nitric oxide.  What happens after prolonged exposure to nitgolycerin, the nitric oxide which is what nitroglycerin acts through gets to a certain degree depleted.  This has been proven by measuring exhaled nitric oxide levels in the air that humans breathe out.  At that point, the effect of NTG is attenuated.  This is why when doctors prescribe nitrglycerin paste, or spray, they always suggest having an 8 hour period of being drug free (that usually represents the time during our sleep) such that those Nitric oxide supplies can be repleted.  Of course, not everyone reacts the same way and some patients can still derive some benefit from having additional NTG, it's just that the full effect isn't there.  There are long acting nitrates formulation such as Imdur SR, but it essentially has the same pharmacokinetics in that it only acts for about 16 hours, and the remaining 8 hours the patient is effectively drug free.  Hope this helps.          

[Healthyself2]

You're endothelial system is in the business of producing NO.  A healthy endothelial system = sufficient NO production.  Artificial NO ingestion blocks the bodies response to physical demand and is counterproductive to the viability of the natural NO production process.

Addressing the two root causes which brought you to the need for NO supplementation should be your primary mission.  Reduction of demand on your heart from obesity.  Improved perfusion of the heart muscle by reducing plaque volume and viscosity.  Improved production and response to physical demand for NO by improving the general health of your endothelial system.

[Healthyself2]

That's assuming a diagnosis of ischemic cardiovascular disease caused by lipid imbalance and probably doesn't apply to other causes.

[joanincarolina]

You are correct. I do not have ischemia from lipid imbalance. And my primary mission is to not develop placque or further narrowing of ANY cardiac vessels.Not obese. I've had 3 clear heart caths, L and R. No pulmonary issues. Never smoked, no illicit drugs or alcohol, always heavy exercise; lipids never bad and are T: 139, HDL 82, LDL 36,trig 107. On statins now and RX Fish oil, aspirin, Cardizem ( documented LAD spasm) but everthing is relieved by nitro (SOB, CP, chest tightness).Wear 2- 0.6mg nitro patches 24/7 so I'm nitro dependent. Without it, as thru other meds trials, I am down for the count. I've tried l'arginine w/o improvement. Diet is 'oldways pyramid' and has been for many years prior to my first symptom of cardiac microvascular dysfunction.So I have what's referred to as non-obstructive vasospastic angina; the spasms from microvessels that back up to LAD.So as this dysfunction progresses, I need to be real clear on whether this is more myocardium microvessel damage, or increased tolerance to nitro. Either way, I'm between a rock and a hard place.And there's no consensus among researchers as to the 'why or what' this is or how to treat or avoid it. Emory U. believes I fall into the category of not producing enough nitric oxide as my response to nitroglycerine is excellent, therefore my receptors in the endothelial are functioning. Thanks for the response. Joan.  

[Healthyself2]

It sounds like you are not going to have any effect on this with drugs or lifestyle changes or whatever.  That's a fact.  Also the nitro will eventually not be effective as you develop tolerance for it.  But the good thing is that it's not going to kill you, it just hurts like hell and limits your life.

Okay, I'm a bit wacko by most people's standards, but think that you need to seek help in another direction.  Your answer is not in modern medicine.  I can't think of any solution that they have for you.

This condition is the universe forcing you in the most severe way to find an answer.  Your heart is not diseased, but is leading you.  Consider a spiritual quest and learning meditation from a master.  I'm quite serious and if your heart is serious you will have little choice as the Nitro loses it's effectiveness.  We live at least 90% in the mind and spirit and no more than 10% in the body.

[Healthyself2]

One other thing stands out in your message. "Always heavy exercise".  That's an American belief that more is better.  My opinion is that more can be harmful to your heart.  My opinion is that the most heart healthy exercise is mildly aerobic long duration, such as relaxed swiming or walking a few miles with some ups and downs.  Heavy exercise can damage the heart and coronary arteries in some people.

[joanincarolina]

Well arn't you the cheery one! And you're right, there's not much I can do about this except try to prevent blockages/narrowing in the microvessels, even tho' this may not be the "cause" given the nitro response. And I have zero expectation from anything further in medicine to assist. This will get me. Each time, or over a period of 'x' time those tiny microvessels actually cause infarcts which eventually will lead to damaged myocardium and if enough of them have bad behaviour at the same time those spasming microvessels cause a back up reaction and spasm to the large coronaries. My comment of 'heavy' exercise is that I've always had exercise with great endurance and that along with normal life stressors, no smoking, good food, appears to have my larger coronaries looking great.I do agree with you that aerobic, frequent,consistent duration exercise is fine. We are animals, not vegetables, and were designed to move. I miss the exercise and have tried some Pilates and Yoga but can't do it..a gallon of milk  is trouble to lift! I do like your 'wacky',out of the norm comments-but straight talk is what works for me. And I'm actually OK with my spirit on this.I could bury my head in the sand, worry needlessly about this and THEN get run over by a mack truck! My main mission here at this site is to get the message out to women to not ignore their cardiac symptoms even tho' modern medicine and all the technology available may be only able to 'assume' an answer and say "everything looks fine".SO in the words of my son, the Yoga guru, "It appears to be what it is" in reference to my heart. So I appreciate your input and reading your profile, I'm happy you made it through your heart issues.:) Joan.

[Healthyself2]

In my case, I only made it through 10 years.  I've been actively killing myself for serveral years now with fat food and alcohol.  It seems that I can't remember wanting and striving to survive 10 years ago.

Anyway, it's hard to say how it's going to turn out,  I feel like I'm turning a corner now, but it may be too late.  But I do know that bypass surgery of sticking metal objects in my coronary arteries would have been a mistake, and I doubt that I would be alive now if that would have happened.