Aa
Aa
A
A
A
Close
712042 tn?1254569209

Tolerance to nitroglycerine?

I am nitro dependent 24/7 and have posted here before regarding my diagnosis severe cardiac microvascular dysfunction. I battle this non-obstructive macrovessel angina everyday wearing two 0.6mg patches and supplementing at least every two days with up to two nitro 0.4 mg sprays to pull me out of an episode. This top amount of .20 mg is the same amount of IV nitro used during my arrest in May '08 to 'stabilize' me ( EF was 64). I used to be able to do well in '08 on just 0.4mg patch but I've progressively had more episodes in '09 and with minimum exertion since 8-1-09. The increase in episodes and some spasms leads me to think that I am developing more areas of myocardium damage. My local cardiologist feels it's nitro tolerance. Since my first random symptoms (CP&SOB) in 2005 to current date symptoms, I believe that this endothelium dysfunction is progressive.I can't track down information regarding this nitro subject except with regard to IV nitro where tolerance has been observed. PS. May lipids: total-139, HDL 82, LDL 36,trig 107.  Thanks...again.
1 Responses
Sort by: Helpful Oldest Newest
367994 tn?1304953593
Journal of Clinical Investigation, volume 113: For more detail information.

Organic nitrates have been used widely in the treatment of both coronary artery disease and congestive heart failure. The most commonly used organic nitrates are nitroglycerin, isosorbide dinitrate, and isosorbide-5-mononitrate (1). The organic nitrates are prodrugs, undergoing a biotransformation process that is generally believed to yield NO or some NO adjunct as their vasoactive metabolite. Despite clear benefits when given acutely, the organic nitrates rapidly lose their hemodynamic and clinical effectiveness when used as sustained therapy, a phenomenon known as nitrate tolerance. The mechanism of nitrate tolerance has been the subject of numerous investigations and much debate. Initially, it was hypothesized that tolerance was caused by abnormalities in the nitrate biotransformation process (termed mechanism-based or classical tolerance); however, those studies were limited by our lack of understanding of the biochemical processes involved. Many other theories have been proposed, including reflex hormonal and neurochemical mechanisms (termed pseudotolerance), although a clear cause-and-effect relationship could not be established.....
Helpful - 0
Have an Answer?

You are reading content posted in the Heart Disease Community

Top Heart Disease Answerers
159619 tn?1707018272
Salt Lake City, UT
11548417 tn?1506080564
Netherlands
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
Is a low-fat diet really that heart healthy after all? James D. Nicolantonio, PharmD, urges us to reconsider decades-long dietary guidelines.
Can depression and anxiety cause heart disease? Get the facts in this Missouri Medicine report.
Fish oil, folic acid, vitamin C. Find out if these supplements are heart-healthy or overhyped.
Learn what happens before, during and after a heart attack occurs.
What are the pros and cons of taking fish oil for heart health? Find out in this article from Missouri Medicine.
How to lower your heart attack risk.