A 60-year-old man with known coronary artery disease visits the office because he has been experiencing exertional chest tightness for the last 6 months. The symptoms appear when he walks more than three blocks, particularly in cold weather. Three years ago, the patient underwent coronary artery bypass graft surgery for progressive angina. Asthma, benign prostate hyperplasia, and peripheral artery disease have all been mentioned in the past. The doctor suggests that the patient add isosorbide dinitrate to his current therapy, but the patient is concerned about the side effects. Which of the following is most likely to occur in this patient with the add-on therapy?

Question

Quizplus · Accepted Answer

Eductional Objective: Nitrates are frequently used to relieve symptoms in patients with chronic stable angina. Nitrates' anti-ischemic effect is mediated by systemic vasodilation (primarily venodilation) with a decrease in left ventricular end-diastolic volume and wall stress, resulting in decreased myocardial oxygen demand and angina relief.
Headaches, cutaneous flushing, lightheadedness, hypotension, and reflex tachycardia are the most common side effects of nitrate therapy. Patients with hypertrophic cardiomyopathy (due to increased outflow tract obstruction), right ventricular infarction (due to decreased preload, impairing cardiac output), and those taking phosphodiesterase inhibitors should avoid nitrates (synergism increases the risk of severe hypotension)

A 60-Year-Old Man with Known Coronary Artery Disease Visits the Office