After the patient's anginal pain is relieved he says to the nurse, "That nitroglycerin works great. How does it do that?" What is the nurse's best response?
A) "Nitroglycerin decreases the amount of oxygen needed by the heart to function."
B) "Nitroglycerin makes the coronary arteries open much wider."
C) "Nitroglycerin promotes growth of new, smaller arteries to supply oxygen to the heart."
D) "Nitroglycerin decreases preload and afterload."
A
Feedback:
The main effect of nitrates seems to be related to the drop in blood pressure that occurs. The vasodilation causes blood to pool in veins and capillaries, decreasing preload, while the relaxation of the vessels decreases afterload. The combination of these effects greatly reduces the cardiac workload and the demand for oxygen, thus bringing the supply-and-demand ratio back into balance. Because coronary artery disease causes a stiffening and lack of responsiveness in the coronary arteries, the nitrates probably have very little effect on increasing blood flow through the coronary arteries, so it would be incorrect to say that the coronary arteries become much wider. Although both preload and afterload are reduced, this is an explanation that the patient would not understand, so it is inappropriate. Nitroglycerin does not promote growth of compensatory circulation.
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