By Dr. Adam Schneeweiss, Dr. Marija Weiss (auth.)
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4. Secondary Prevention After Acute Myocardial Infarction Several anti-ischemic agents have been shown to reduce mortality and morbidity in patients after acute myocardial infarction. This was shown in late and/or early intervention studies with beta-blockers (propranolol, metoprolol, timolol) and calcium antagonists (diltiazem). Nifedipine is now being studied for this indication. An attempt to use nitrates for secondary prevention appears promising. The anti-ischemic effect of nitrates may be especially beneficial in early-intervention studies.
In certain patients sublingual nitroglycerin had only a partial or no beneficial effect. Some of these patients responded better to intravenous nitroglycerin [80, 81]. Transdermal administration was also found to be effective. 4 in ten patients with vasospastic angina pectoris. The most effective form of nitrate administration is by the intracoronary route. Buxton and coworkers  reported that intracoronary administration of nitroglycerin relieved ergonovine-induced coronary spasm refractory to other forms of administration of the drug.
This finding shows some attenuation of the effect ofISDN, but no cross-tolerance to nitroglycerin. 5. Hemodynamic Effects of Bolus Nitroglycerin Compared with Those of Continuous Infusion When administered intravenously, nitroglycerin is usually given in the form of continuous infusion. Most hemodynamic studies have been performed with this mode of administration. Recently it was shown that the hemodynamic effects of bolus injection of nitroglycerin in patients with coronary artery disease might be different from those of a continuous infusion.