[Answered]: A 65-year-old man with a history of coronary…

A 65-year-old man with a history of coronary artery disease presents to your office complaining of chest pain on exertion. The patient underwent a recent cardiac workup that showed no evidence of myocardial ischemia. The patient was prescribed sublingual nitroglycerin at the last visit for symptomatic relief of stable angina. On further questioning, the patient states that he has been swallowing the tablet whole instead of allowing it to dissolve because he “does not like the taste.” What is the cause of the patient’s persistent symptoms? A. Coronary steal syndromeO B. Nitroglycerin toleranceO C. Unstable anginaO D. First-pass metabolism of nitroglycerin E. Concomitant use of sildenafil