passages.id: 5271
passages.type: title
passages.text: Myocardial infarction following sublingual administration of isosorbide dinitrate.
passages.id: 5272
passages.type: abstract
passages.text: A 78-year-old with healed septal necrosis suffered a recurrent myocardial infarction of the anterior wall following the administration of isosorbide dinitrate 5 mg sublingually. After detailing the course of events, we discuss the role of paradoxical coronary spasm and hypotension-mediated myocardial ischemia occurring downstream to significant coronary arterial stenosis in the pathophysiology of acute coronary insufficiency.