Paradoxical Angina after Nitroglycerin — Another Variant

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Abstract
To the Editor: We have recently observed a patient in whom chest pain and ST-segment elevation paradoxically developed after the administration of nitroglycerin. The patient was a 53-year-old woman with Class II angina pectoris who had a single stenosis of a large diagonal branch of the left anterior descending coronary artery. Because the patient had had a normal coronary angiogram 15 months before, we considered coronary-artery spasm as a possible cause and injected nitroglycerin into the left coronary artery in an attempt to relax the stenosis. Within one minute of injection of 160 μg of nitroglycerin through the left coronary-artery . . .