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Hold the Nitro?

Tuesday, March 29, 2005; Page HE02

Poor Diagnostics More people rush to emergency rooms for chest problems than for any other symptom except abdominal pain. Often, a doctor's first response is to place a nitroglycerin pill under a patient's tongue. The drug relaxes blood vessels, speeding blood flow to the heart. Patients whose pain quickly subsides are usually thought to have coronary artery disease. But new research is questioning that assumption. A study in the Annals of Emergency Medicine shows that while nitroglycerin may relieve chest pain, a positive response isn't necessarily an indicator of heart disease.

Missing Link The study, by emergency physicians and cardiologists from the University of California Davis Medical Center in Sacramento, followed 345 women and 319 men who arrived at the ER complaining of chest pain; all were given nitroglycerin. About 81 percent of the patients said they felt better after taking the pill; 28 percent said their chest pain disappeared completely or almost completely.

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But researchers found no link between reduced discomfort and the presence of heart disease: Patients who reported a lessening of pain were almost equally divided between those later shown to have heart disease and those found not to have the condition. Patients without heart disease may have felt better after nitro, researchers speculated, because the drug might have relaxed muscle spasms or because of a placebo effect.

Meanwhile, 25 percent of those with heart disease and 19 percent of those without heart disease reported no benefit from nitro.

Now What? Susan K. Bennett, clinical director of the Women's Heart Program at George Washington University Hospital, said the findings would guide diagnostics only, not treatment. "We know the effects of nitroglycerin [on pain] and we'd never withhold nitroglycerin," she said. People with heart disease who have been instructed to carry nitroglycerin should continue to do so, she added.

-- Rebecca Adams

© 2005 The Washington Post Company


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