Defining the Proper Role for Selfadministered Sublingual Nitroglycerin (2)

During the night, the patient had intermittent chest pain that seemed to respond transiently to repeated doses of sublingual nitroglycerin. In the morning, the patient returned to the hospital where an ECG demonstrated ST-elevation and Q-waves in the anterior precordial leads. When asked what he would have done when the chest pain recurred at home had he not had nitroglycerin tablets, the patient stated unequivocally that he would have returned to the emergency department immediately.
Case 3
A 49-yeai^old man was hospitalized with an acute inferior myocardial infarction. Several hours after admission, he mentioned to the nurse that he was having mild chest pain, and he was given a sublingual nitroglycerin tablet. He immediately began to feel faint and became pale. Blood pressure fell to 60 mm Hg systolic, and pulse to 45/min. The patient was placed in the Trendelenburg position and felt better. After 20 minutes he was able to sit up. ampicillin antibiotic
Three days later the patients attending internist ordered the administration of a test dose of sublingual nitroglycerin to make sure the patient would no longer have an adverse reaction to the nitroglycerin tablets that he would be prescribed on discharge for future use as needed. The patient refused the nitroglycerin, and the attending internist was unhappy with the CCU-rounding cardiologist s refusal to convince the patient to try the drug.