Skip Navigation
American College of Physicians Logo
  • Subscribe
  • Submit a Manuscript
  • Sign In
    Sign in below to access your subscription for full content
    INDIVIDUAL SIGN IN
    Sign In|Set Up Account
    You will be directed to acponline.org to register and create your Annals account
    INSTITUTIONAL SIGN IN
    Open Athens|Shibboleth|Log In
    Annals of Internal Medicine
    SUBSCRIBE
    Subscribe to Annals of Internal Medicine.
    You will be directed to acponline.org to complete your purchase.
Annals of Internal Medicine Logo Menu
  • Latest
  • Issues
  • Channels
  • CME/MOC
  • In the Clinic
  • Journal Club
  • Web Exclusives
  • Author Info
Advanced Search
  • ‹ PREV ARTICLE
  • This Issue
  • NEXT ARTICLE ›
Summaries for Patients |16 December 2003

Does Chest Pain Relief with Nitroglycerin Mean Coronary Artery Disease?

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • The summary below is from the full report titled Chest Pain Relief by Nitroglycerin Does Not Predict Active Coronary Artery Disease. It is in the 16 December 2003 issue of Annals of Internal Medicine (volume 139, pages 979-986). The authors are C.A. Henrikson, E.E. Howell, D.E. Bush, J.S. Miles, G.R. Meininger, T. Friedlander, A.C. Bushnell, and N. Chandra-Strobos.


Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
×
  • ‹ PREV ARTICLE
  • This Issue
  • NEXT ARTICLE ›
Jump To
  • Full Article
  • FULL ARTICLE
    • What is the problem and what is known about it so far?
    • Why did the researchers do this particular study?
    • Who was studied?
    • How was the study done?
    • What did the researchers find?
    • What were the limitations of the study?
    • What are the implications of the study?
  • Figures
  • Tables
  • Supplements
  • Audio/Video
  • Summary for Patients
  • Clinical Slide Sets
  • CME / MOC
  • Comments
  • Twitter Link
  • Facebook Link
  • Email Link
More
  • LinkedIn Link
  • CiteULike Link

What is the problem and what is known about it so far?

Chest pain is a common symptom that can be caused by several conditions. Cardiac causes of chest pain, such as angina and heart attack, are serious and usually require prompt medical attention and treatment. Other causes of chest pain, such as spasm of the esophagus or inflammation of the chest wall, may be less serious and require different treatment than does chest pain related to heart conditions. Therefore, an accurate diagnosis is important to guide proper treatment of patients with chest pain.
Nitroglycerin, a drug that dilates blood vessels, is commonly used to relieve chest pain caused by coronary artery disease. It also relaxes the smooth muscles of vessels and can relieve chest pain from esophageal spasm. Because of its different actions, researchers wonder whether relief of acute chest pain with nitroglycerin reliably indicates that pain was caused by coronary disease.

Why did the researchers do this particular study?

To see whether pain relief by nitroglycerin correctly identifies patients with acute chest pain who have coronary artery disease.

Who was studied?

459 adults with acute chest pain who were admitted to an urban community teaching hospital through the emergency department.

How was the study done?

A health care provider gave nitroglycerin (spray or tablet under the tongue) to patients visiting the emergency department for evaluation of chest pain. Using a standard form, patients rated the severity of their chest pain immediately before and about 5 minutes after receiving nitroglycerin. The researchers labeled pain as relieved if there was a 50% or greater reduction in the intensity of chest pain. All patients were admitted to the hospital for further observation or tests to evaluate the presence of active coronary artery disease. The researchers called patients about 4 months after hospitalization and reviewed medical records to see whether any had died or had repeated hospitalizations, heart attacks, or heart procedures.

What did the researchers find?

Nitroglycerin relieved pain in 39% of all patients. It relieved pain in 35% of the patients who had subsequent evidence of active coronary disease. It relieved pain in 41% of the patients who had no subsequent evidence of active coronary disease. At 4 months, there were no major differences in outcomes between patients who did and did not have pain relieved by nitroglycerin.

What were the limitations of the study?

The doctors who were caring for the patients were aware of the reported responses to nitroglycerin. This may have influenced their decision to further test for coronary artery disease. Also, all patients didn't get the same tests to diagnose or exclude active coronary disease.

What are the implications of the study?

In emergency department settings, relief of chest pain with nitroglycerin does not help diagnose active coronary artery disease.

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

This feature is available only to Registered Users

Subscribe/Learn More
Submit a Comment

0 Comments

PDF
Not Available
Citations
Citation

Does Chest Pain Relief with Nitroglycerin Mean Coronary Artery Disease?. Ann Intern Med. 2003;139:I–30. doi: 10.7326/0003-4819-139-12-200312160-00003

Download citation file:

  • RIS (Zotero)
  • EndNote
  • BibTex
  • Medlars
  • ProCite
  • RefWorks
  • Reference Manager

© 2018

×
Permissions

Published: Ann Intern Med. 2003;139(12):I-30.

DOI: 10.7326/0003-4819-139-12-200312160-00003

©
2003 American College of Physicians
0 Citations

See Also

Chest Pain Relief by Nitroglycerin Does Not Predict Active Coronary Artery Disease
View MoreView Less

Related Articles

Chest Pain Relief by Nitroglycerin Does Not Predict Active Coronary Artery Disease
Annals of Internal Medicine; 139 (12): 979-986
Annals for Educators - 19 January 2016
Annals of Internal Medicine; 164 (2): ED2
Multicenter Validation of the Diagnostic Accuracy of a Blood-Based Gene Expression Test for Assessing Obstructive Coronary Artery Disease in Nondiabetic Patients
Annals of Internal Medicine; 153 (7): 425-434
Cost-Effectiveness of Diagnostic Strategies for Patients with Chest Pain
Annals of Internal Medicine; 130 (9): 709-718
View MoreView Less

Journal Club

In patients with chest pain, HEART score–guided and usual care did not differ for MACE or health care use
Annals of Internal Medicine; 167 (4): JC22
Review: In patients with chest pain, risk scores better predict high risk for ACS than individual risk factors
Annals of Internal Medicine; 164 (6): JC34
Some risk scores plus high-sensitivity troponin may identify patients with chest pain for early discharge
Annals of Internal Medicine; 164 (4): JC22
Glyceryl trinitrate did not improve functional outcome in patients with acute stroke and high BP
Annals of Internal Medicine; 162 (8): JC12
View MoreView Less

Related Topics

Cardiology
Coronary Heart Disease

Cardiology, Coronary Heart Disease.

CME/MOC Activity Requires Users to be Registered and Logged In.
Sign in below to access your subscription for full content
INDIVIDUAL SIGN IN
Sign In|Set Up Account
You will be directed to acponline.org to register and create your Annals account
Annals of Internal Medicine
CREATE YOUR FREE ACCOUNT
Create Your Free Account|Why?
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
The Comments Feature Requires Users to be Registered and Logged In.
Sign in below to access your subscription for full content
INDIVIDUAL SIGN IN
Sign In|Set Up Account
You will be directed to acponline.org to register and create your Annals account
Annals of Internal Medicine
CREATE YOUR FREE ACCOUNT
Create Your Free Account|Why?
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
link to top

Content

  • Home
  • Latest
  • Issues
  • Channels
  • CME/MOC
  • In the Clinic
  • Journal Club
  • Web Exclusives

Information For

  • Author Info
  • Reviewers
  • Press
  • Readers
  • Institutions / Libraries / Agencies
  • Advertisers

Services

  • Subscribe
  • Renew
  • Alerts
  • Current Issue RSS
  • Online First RSS
  • In the Clinic RSS
  • Reprints & Permissions
  • Contact Us
  • Help
  • About Annals
  • About Mobile
  • Patient Information
  • Teaching Tools
  • Annals in the News
  • Share Your Feedback

Awards

  • Personae Photography Prize
  • Junior Investigator Awards
  • Poetry Prize

Other Resources

  • ACP Online
  • Career Connection
  • ACP Advocate Blog
  • ACP Journal Wise

Follow Annals On

  • Twitter Link
  • Facebook Link
acp link acp
silverchair link silverchair

Copyright © 2018 American College of Physicians. All Rights Reserved.

Print ISSN: 0003-4819 | Online ISSN: 1539-3704

Privacy Policy

|

Conditions of Use

×

You need a subscription to this content to use this feature.

×
PDF Downloads Require Access to the Full Article.
Sign in below to access your subscription for full content
INDIVIDUAL SIGN IN
Sign In|Set Up Account
You will be directed to acponline.org to register and create your Annals account
INSTITUTIONAL SIGN IN
Open Athens|Shibboleth|Log In
Annals of Internal Medicine
PURCHASE OPTIONS
Buy This Article|Subscribe
You will be redirected to acponline.org to sign-in to Annals to complete your purchase.
CREATE YOUR FREE ACCOUNT
Create Your Free Account|Why?
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
Access to this Free Content Requires Users to be Registered and Logged In. Please Choose One of the Following Options
Sign in below to access your subscription for full content
INDIVIDUAL SIGN IN
Sign In|Set Up Account
You will be directed to acponline.org to register and create your Annals account
Annals of Internal Medicine
CREATE YOUR FREE ACCOUNT
Create Your Free Account|Why?
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×