Nitroglycerin tolerance mechanism in chronic angina

A 58-year-old man with a 10-year history of stable angina presents to your clinic. He has been wearing a continuous transdermal nitroglycerin patch without interruption for the past 3 weeks. He reports that the patch no longer relieves his typical exertional chest discomfort as it did initially. Which of the following mechanisms is most likely responsible for his reduced response to nitroglycerin?

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Nitroglycerin tolerance mechanism in chronic angina | QWorld.Ai