Salve for the Aching Heart

Abstract

After 20 years of undeserved neglect, nitroglycerin ointment is now coming into its own. The need for it is obvious. Sublingually administered nitroglycerin, with its fleeting effect, is inadequate for unstable nocturnal or variant angina. Long-acting nitroglycerin preparations for oral administration lose much of their effectiveness through inactivation of nitrate in the liver. In bypassing the portal circulation, nitroglycerin ointment offers a logical alternative. That the alternative is also practical has been confirmed by recent clinical trials. Reichek and associates 1 reported gratifying subjective and objective results with the use of this ointment. Not only was angina forestalled in the 14 patients they studied, but there was a substantial enhancement of exercise capacity, lowering of systolic blood pressure, increase in heart rate, and diminution of exerciseinduced ST segment depression. These effects, which lasted three to five hours, were undiminished after a three-month trial in six of these patients. No evidence