Effectiveness of intravenous administration of nicorandil in a patient with variant angina refractory to continuous intravenous nitroglycerin

Variant angina usually responds to conventional treatment with nitrates and calcium antagonists. However, severe variant angina refractory to intensive anti-anginal treatment can be catastrophic because prolonged occlusion of a major coronary artery can result in myocardial infarction, severe cardiac arrhythmia, and sudden death. We report a patient with active variant angina which was refractory to conventional treatment including sublingual nitroglycerin and intravenous nitroglycerin administration. Only intravenous administration of nicorandil was consistently effective in eliminating chest pain of the patient.