Just wondering of anyone else has been prescribed GTN spray for chest pain with AFib/Arrhythmias. Called my surgery as the Amiodarone dose [100mg] daily is 'wearing off' - sometimes late afternoon and into evening. Episodes last from minutes up to 7 hours or so and as they get more prolonged the chest pain gets really really uncomfortable/sore and radiates to my back in between shoulder blades - BP elevates [highest been 179] and generally feel really unwell. I am awaiting another Echocardiogram but depends on waiting list. My surgery tried to 'push' me up the list but Electrophysiologist says I need referred to different cardiology department. The frustrating thing is when I take my dose I am in NSR and the ECG at the surgery is always 'normal' but I know by the end of the day it's not going to be. I have been advised to use the spray, but if it has no affect to call 999. Sorry for the long story, but, will leaving the daily arrhythmias to go on for hours with the pain have an adverse affect on my heart. My heart rate is between 48 -52 but can go as high as 183bpm. It can be only 70/80bpm but is still really sore. Any advice/reassurance would be great and thank you for taking the time to read this.
GTN Spray: Just wondering of anyone... - Atrial Fibrillati...
GTN Spray
It seems strange but I fear that chest pain with AF may well be a female thing as so far the only members who have reported it here seem to have been such. That said some 30 years ago when I presented to my GP with what subsequently turned out to be AF his first reaction was to call it angina and prescribe a GTN spray. Frankly , apart from giving me a monumental headache it did nothing for my chest. Fortunately a house move and change of GP did actually discover the AF and I got proper treatment thereafter.
Hi Bob, thanks for your reply. I don't know if I have a 'complex' heart issue?? as when they tried the ablation every time he tried to target an area it just jumped to the next one - forgive my ignorance in trying to describe the procedure so he had to stop. Overnight in hospital my HR elevated to 179 and they just couldn't get it to revert back and that's why I ended up in CCU for 24 hours whilst they administered the Amiodarone. The Cardioversion worked initially but getting back to 'square one' as they say with symptoms but this time around they are a lot more uncomfortable and stronger. I to, have had the GTN in back of ambulance and initially it did work. On my discharge notes I read that I was at significant risk of Atrial Myopathy which as I asked Nurse is, I believe, hardening of the Arteries?? I am not a 'worrier' but I must admit after 4 years of symptoms it's wearing me out physically and mentally. My last appt. with E.P was recommendation of a pacemaker as I cannot get any higher dose of the Amiodarone. I am hopeful that between the surgery and the hospital they can come to some sort of conclusion - perhaps after they have referred me to another Cardiology Dept.
GTN spray widens the blood vessels so that blood flows more freely around the heart. On the odd occasions l have been to A/E in an ambulance, the paramedics gave me the spray for chest pain. It did help, but as Bob says it can leave you with an almighty headache. GTN spray is prescribed for angina amongst other things. I would ask your GP some questions here l think. I would not be happy with high numbers so it sounds as if you need a drugs review and more help. I can get pain between my shoulder blades with AF., but also with digestive problems. This must be causing you anxiety which makes things worse, so don’t suffer in silence.
Hello, yes I have called my surgery as my symptoms are daily now and extremely uncomfortable - they then e mailed my EP but he replied back that if I was having chest pain then I would have to be referred to a different Cardiology Dept. I am at a bit of a loss now as I understood chest pain was part and parcel of AFib/Arrhythmias?? I to have had digestive symptoms and the nausea that accompanies these episodes is, in a word, debilitating. Lying down makes everything worse so add in sleepless night to. Just a waiting game now me thinks but if they last for hours again I will be calling for help.
It’s the waiting that is the problem. If you are going to a different department then it has to be the “plumber” and not the “electrician”. Perhaps you need an angiogram if you haven’t already had one. That would show the health of your arteries. I hope you soon get to the bottom of all this, as l am sure you will eventually. I think many of us would be much better if we didn’t have to wait. If you are worried l would go to AE. Perhaps they will chase your appointment for you, they have mine and l have now got appointment 20th November. I wish you well. Let us know how you are.
Thank you I will let you know how things go. I wish you well to. Take care.
Look after yourself and don’t hesitate to go to AE if you have pain. The paramedics told me they would rather come out 10 times than me have a heart attack. If l don’t feel things are right l just pick up the phone - no messing! Take care xxxx
If you haven't already, I would go to the A&E the next time you have that kind of radiating chest pain so they can do a complete cardiac work up and rule out something more serious like angina or a heart attack. I would not wait till your doctor gets around to doing an echo.
Jim
Thank you Jim. Rest assured I will be calling 999 as I explained to the Nurse that they have to see what is actually happening, but like many others, it's a case of being older [67] and not wanting to bother emergency services in case there is someone else in greater need. It's all being getting worse since beginning of August on a daily basis and quite frankly I have come to the end of my tolerance because of the discomfort. The last time I was in A and E was after my Cardioversion in August last year and I was told by a very stern Doctor on that night 'that A and E wasn't the place to come to get my medication adjusted.' They had me on a high dose of Bisoprolol along with my Amiodarone, which I tried to say to them might be too high, but as you know when you call Surgery they will not adjust/increase/decrease any heart medications without the say so from Cardiology..
it's a case of being older [67] and not wanting to bother emergency services in case there is someone else in greater need.
Chest pain radiating into your back is not "bothering" anyone. It's potentially a true emergency and you have to ve seen. And you want be seen while you're having these pains so they can run the appropriate bloodwork and possibly other test testing.
Jim
Thanks Jim. The advise from my own Doctor yesterday was to use the spray and if it doesn't work then call 999, but I will be calling them straight away and not waiting to see if the spray works or not as I really want some answers now and when I asked the Nurse her reply was she wasn't the one to be asking and it should be Cardiologist which I perfectly understand.
I would follow your doctor's advice to use the gtn spray as soon as you feel pain. But given the cloud surrounding your diagnosis, I would still call 999 and request an ambulance, whether the pain goes away or not. and hopefully they can get to the bottom of the matter.
Gtn spray is typically given for angina pain and not for afib. Has your doctor mentioned angina to you?
Just because you're getting pain when you go into afib doesn't mean the pain is from afib. It could be from angina, and if so it's best to have a medically addressed as soon as possible rather than waiting for an office appointment. Unless of course your doctor is already on top of the angina diagnosis, which it sounds they may not be.
Also at the hospital, they can also run tests to make sure no further damage is done.
Jim
Thank you Jim for your reply. I am at the stage where I really am finding it difficult to cope and I don't give in easily - I just want to curl up in a ball until the pain goes away. I have told my Surgery about the pain getting worse with each episode and I feel that I have to keep saying that I don't panic, because I really don't as I would imagine this would increase heart rate along with chest pain. I think the spray was given to me as a 'safeguard' maybe in case there might be undiagnosed angina. I have multiple TC's so it was written that further 'mapping' of the AT's would possibly, be too complex. I try to understand my Ep's observations on my discharge letter but the mapping bit I really have no idea - I tried to imagine it as an 'old distributor cap' on a car and they have a specific 'firing' order so maybe that's how your heart beats??? in specific order - my ones all want to 'fight' with one another to be the lead ha ha!!!
Yes I have afib. The chest pain can get quite bad. Sometimes I end up in a an e. Heart goes up to about 180bpm. My spray helps somewhat. The pain in-between my shoulder blades can continue after my afib episodes. I have had about 4 years now. The ane department always insist it's angina as well as afib.Ive had abulation and cardio versions, but although episodes are less I still get my chest pain with afib.
Thanks for your reply. I to have had this for over 4 years now. The chest pain is stronger and it takes me several days to recover from episodes now - basically I do practically nothing as it totally saps all of my energy. My problem is I don't go to A and E but sit it out but I have told myself to go especially for the long 6 to 8 hour episodes. Take care.
Yes, I have but never used it, my mother too for her Angina. I was told that if I used it I should lie down and that it would give me a really bad headache.
I'd go to A&E if my HR got that high as I'd be struggling to breathe but then I usually need cardioverting. I was given a gtn by local hospital but it just gave me a headache and did nothing for the afib or discomfort of the chest.
Mine can drop to 39 or shoot up to high hundreds. For me, Adenosine never works even with the highest doses and I have had many doses over the years. I can only hope that they can get to the root cause of the constant arrhythmias/AFib. Thank you for your reply.
I don’t know the percentage but some sufferers do get chest discomfort with their AF. I sometimes get much the same as you but less pronounced - more a kind of chest ache, but in the same area as yours.
AF always reduces the heart’s pumping ability but by variable amounts, I gather. This can cause mild angina (i.e. when the heart muscle itself needs more oxygen). If the GTN spray helps, this will be what you have. If it doesn’t, the cause lies elsewhere. AF can affect the digestive area and diaphragm, too, in my experience - both mimicking heart pain at times.
I would guess your first scan was satisfactory so nothing is likely to have changed. The second scan will likely show much the same. If I were you, my anxiety would likely push me to pay for a private echo scan - I think under £500?
Steve
Hi there - my very first scan back in 2020 was up in an area of Scotland called Moray. The Cardiologist only asked for half of my heart to be scanned!!! when I moved back through to Aberdeen I had an excellent and still have EP. He couldn't understand why they only scanned half of my heart so I had a full heart scan in 2021 - I have 'stretching' of atria?? - sorry am not heart term savvy and that was picked up on the scan with other observations. After my latest follow up in May this year he has requested another scan as I am still symptomatic and guess he's just making sure that there are no other changes to my heart aggravating the arrhythmias/AFib. I don't really get anxious to be honest but now because of the really sore chest pain and length of episodes I hope to get more answers although I have been told pace/ablate may now be the only solution. Thanks for your reply I really appreciate it.
I didn't know thy could ultra-sound scan half a heart - how odd. Or was it an MRI? Mind you, it's only the left ventricle and valves that truly matter to us, I guess.
Pace and ablate has been mentioned to me, but a further ablation will come first, most likely. The "stretching" is what arrhythmias do to the atrium over time, I have read, aided by extra stresses brought on by age, hypertension, obesity, sleep apnoea and other. The heart cells in the varyingly but still very thin-walled atrium become slightly enlarged over time which, I gather, makes certain types of them more prone to firing off of their own accord. These then act like mini-pacemakers and get in the way of the work of the actual pacemaker, the SA or sino-atrial node in the top right of the atrium.
There's quite a bit online about this. Even temporary stretching caused by movement or the effects of adrenaline (i.e. from physical or emotional stress) can set cause this and off ectopic beats, I gather which, in those prone to AF, can trigger it. I would say many of the "triggers" that can easily become a grail to look for, in truth, not this or that food or drink, but a stretching mechanism of some kind. It's possible, anyway and the science is supporting that.
Steve
Many thanks Steve for that explanation. I will do some research on it.
I have a GTN spray but haven’t used it, luckily haven’t needed it recently. When I first developed AF I had the full works, echo, angiogram, stress test. What they found was that my arteries are fine but I get spasms in them. Later I had a ‘heart attack’ which was put down to coronary artery spasm. This type of angina has several names : used to be called Cardiac syndrome X, also Prinzmetal’s angina, and there are two versions, one affecting the large arteries and the other caused by blockages in the tiny vessels. I am speaking from memory so for the full explanation you need to search for ‘coronary artery spasm’ on the BHF website. The nurse told me it tends to happen to ‘ladies of a certain age’ so Bob is right, up to a point! It is also hard to diagnose. I get pain at the base of my throat and running up my neck but the heart attack was the proper ‘bearhug’ effect. It may be of course that you do have clogged arteries but it sounds more like my symptoms. Diltiazem is supposed to help. And a cardiologist would be the person to consult.
I hope that helps and good luck with A&E, hope the ‘stern doctor’ was a one off!
One point you mentioned was about the throat - I actually thought I had something lodged in my throat as it was so tight, along with other symptoms I had another episode that lasted for many hours. Thank you for your input.
Did they never try Flecainide to see if that would work before the Amiodarone?
Hope you get sorted soon
I started off with Bisoprolol then Sotalol and finally Amiodarone. Unfortunately over a time period they have all become less effective and pace/ablate in now only option left for me.
I know someone who has had Pace and abate at 58 years old - he is doing very well with it
Ectopics / unusual sensation 
Afib episode 
AF
PAF well controlled till I got covid
