Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Medical Imaging, Tennessee Valley Healthcare, Nashville, TN, USA.
J Nucl Cardiol. 2018 Oct;25(5):1718-1723. doi: 10.1007/s12350-017-1174-7. Epub 2018 Jan 23.
Vasodilator agents such as adenosine and regadenoson are commonly used pharmacologic stressors to assess for ischemia in patients undergoing myocardial perfusion studies. The recommended reversal agent for this mode of stress is aminophylline, although nitroglycerin is commonly administered as an attempt to reverse the symptoms or electrocardiographic (EKG) changes during the stress test. We demonstrate through two cases that incorrect administration of nitroglycerin can induce hypotension and worsen coronary steal, whereas appropriate administration of aminophylline can reverse the effects of pharmacologic vasodilators. While nitroglycerin is often used in patients with organic angina, it has the potential to worsen ischemia in the setting of pharmacologic vasodilator administration. These cases underscore the importance of administering the correct reversal agent for pharmacologic stress tests.
血管扩张剂，如腺苷和雷加登松，常用于评估心肌灌注研究患者的缺血情况。这种应激模式的推荐逆转剂是氨茶碱，尽管硝酸甘油通常被用作试图逆转应激期间的症状或心电图（EKG）变化。我们通过两个案例表明，硝酸甘油的不正确给药会导致低血压和加重冠状动脉窃血，而氨茶碱的适当给药可以逆转血管扩张剂的作用。虽然硝酸甘油常用于有机性心绞痛患者，但在给予血管扩张剂时，它有可能加重缺血。这些病例强调了给予正确的血管扩张剂逆转剂进行药物应激测试的重要性。
