A 62-year-old man comes to the physician because of a 3-month history of intermittent retrosternal chest pain and tightness on exertion. He has type 2 diabetes mellitus and hypertension. Current medications include insulin and enalapril. Vital signs are within normal limits. His troponin level is within the reference range. The patient is prescribed a medication that is metabolized to S-nitrosothiols in the vascular smooth muscle cells, and he reports rapid and significant symptom relief. Which of the following components of the cardiovascular system is most susceptible to the medication prescribed to this patient?

Question

A 62-year-old man comes to the physician because of a 3-month history of intermittent retrosternal chest pain and tightness on exertion. He has type 2 diabetes mellitus and hypertension. Current medications include insulin and enalapril. Vital signs are within normal limits. His troponin level is within the reference range.  The patient is prescribed a medication that is metabolized to S-nitrosothiols in the vascular smooth muscle cells, and he reports rapid and significant symptom relief.  Which of the following components of the cardiovascular system is most susceptible to the medication prescribed to this patient?

Quizplus · Accepted Answer

Eductional Objective: Pharmacologic nitrates (eg, nitroglycerin, isosorbide mononitrate, isosorbide dinitrate) are metabolized to nitric oxide and S-nitrothiols in vascular smooth muscle cells, leading to an increase in cyclic guanosine monophosphate (cGMP) that stimulates vasodilation.  Large veins are predominantly affected, leading to increased venous capacitance and reduced venous return (preload), which decreases left ventricular wall stress and myocardial oxygen demand to relieve anginal symptoms.

A 62-Year-Old Man Comes to the Physician Because of a 3-Month