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To the Editor:—
The answer by George Griffith, MD, to the question, "Nocturnal Angina Pectoris" (JAMA197:519, 1966), appears excellent as far as it concerns the prevention of such attacks through avoidance of food and fluid intake in the evening and positioning of the bed during the night. As supportive measures may be added digitalization, salt-free diet, and diuretics. By avoiding pulmonary congestion this regime may improve oxygenation of the myocardium.In Dr. Griffith's contribution I missed reference to therapy during an actual attack of nocturnal angina pectoris. It was our practice to let the patient first sit up on the edge of his bed. Then he was directed to take a tablet of glyceryl trinitrate sublingually, to stand up, and even to take a few steps in his bedroom. This, of course, is in contrast to the rule that during an attack of angina pectoris after effort the
Fritz Brunn. Nocturnal Angina Pectoris. JAMA. 1966;198(5):564. doi:10.1001/jama.1966.03110180108039