I have angina fairly often. The GTN spray isn't always effective and when this is the case, I don't know what to do. The instructions say to call an ambulance if the angina remains after two separate doses have been taken. If I followed this advice I would be landing in A and E very frequently.
I also have a problem deciding when to use the spray. My blood pressure is sometimes pretty low and on two occasions when I have felt the need to take the spray, my blood pressure has become too low and I have nearly fainted.
I would really like to hear from anyone who has had similar experiences.
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AnneMargaretMary
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I had the angiogram in November 2017. It showed mild to moderate plaque disease in the mid secton of the LAD and moderate borderline ostial disease in the Diagonal.
In the middle of last year, I had a cardiac MRI which I understand showed nothing new, though I was not given a copy of the report. I continued on the original meds.
The angina is unpredictable: I sometime go days and days without it. At times it occurs as a a result of stress or exertion; at others it happens out of the blue. It seems to be both stable and unstable!
I currently have annual appointments at a London teaching hospital.
hello. snap. iv been living like this for about 18 months. i suffer from low blood pressure and gtn has had the effect of lowering lower. i only use it once because of this. iv come to know when i need to go to a&e when it gets too bad. i’m very symptomatic to all the drugs they’ve tried. they have started me on isosorbide 10 mg x2 a day. only been taking it 2 days. so far no apparent reaction to them. hopefully it’ll help instead of taking the spray. i sure hope so. i suggest you sit or lie down when using spray which reduces dizziness. it’s been a long journey but we all have to deal with all our individual journeys. hopefully you’ll get some medication without too many symptoms. good luck on your journey❤️shiona
Hi Shiona, I've had angina on and off for several years. It's not agony but bad enough at times to stop me doing things I want to do. Sorry you're experiencing the same sort of thing.
I take 10mg Isosorbide once a day without any side effects. I hope you find it useful.
I've struggled with low Blood pressure and heart rate with microvascular angina for the last few years. I take a cocktail of medication for the angina ( mononitrate, Ranolazine, Adizem, doxozosin) but I also use nitro patches and GTN spray on bad breakthrough days. Funnily my blood pressure seems more stable after starting all these medications ( it is still low but doesn't drop further).
It is a hard decision knowing when to spray and when to dial 999. I could spray most mornings , afternoons and evenings if I sprayed every time I had pain. I'd also need a season ticket for A&E if I used the spray twice and noticed no relief. If you call 111 they will send an ambulance if needed...I know!!
If you haven't tried a nitro patch try that...it's much kinder to your body I find. Otherwise look at long acting medication to control the angina, discuss with your cardiologist. When I'm really bad my last resort is taking multiple nitro sprays. This reduces the angina but also improves my blood pressure. I always lay down to use it due to the headache.
We are all so different, if you are feeling concerned speak with your cardiologist. If you feel very unwell do call 999. If you're not sure call 111 they are very sopportive.
We seem to be in the same boat when it comes to knowing what to do when the GTN spray doesn't work. I suppose the instructions about calling an ambulance after two ineffective doses are precautionary - but in my circumstances would just not be reasonable.
Many thanks for your advice. I've never heard of nitro patches so will definitely discuss them with my GP. I will ask my cardiologist about long-acting medication when I see him in January.
With regards to GTN lowering your blood pressure, that's literally it's job. The pain from angina is caused by pressure build up (not unlike an MI), and GTN alleviates that to a degree by rapidly expanding your blood vessels - which is why you may feel a bit light headed or get a head rush, because it's not localised, i.e. just your heart, it happens in your brain, too. The instructions therefore also include "sit down comfortably".
Having said that, you shouldn't be experiencing angina that often anyway, and you're doing the right thing by getting to an A&E soon after trying the GTN.
My cardiologist calls me his Marmite patient (I think I'm driving him mad - he says he loves/hates I'm ambulatory to the point of making him wonder why I'm even in his exam room until he looks at my scans) - every test shows I have a very strong heartbeat functioning perfectly with good blood flow to and from, but still experience angina pain on exertion.
I'm having a cardiac MRI next week he's hoping will give him some answers beyond my carefully submitted suggestion maybe the angina is from the pericardial effusion, scarring, and thickening he deems 'slight'. He freely admits I'm a puzzle (and he doesn't like puzzles) but still hasn't released me back to the GP supervision and says he may be years off doing so.
Contrast dye. I've been told to drink plenty of water after to flush the dye from my system.
I've been told possible MVA, 'idiopathic', 'surely not from the pericardial effusion but...' and several other possible explanations, so I'm going to be very interested in hearing what they discover from the MRI. So far I'm responding quite nicely to the Bisoprolol (1.25mg in the morning) and have only needed the GTN five or six times since April - but I still have angina best described as 'fleeting' as it usually stops while I'm locating and priming the GTN, and they want to know why.
A strong but dull ache and again, it usually hits and disappears so fast I rarely have time to get to the spray, it only rarely lasts more than a few minutes as long as I stop moving and wait a few seconds. If I try to carry on it of course goes on to the point I do use the spray, and very occasionally even if I do stop moving it doesn't go away until I use the spray.
I think what frustrates them all most is always without fail on an exercise ecg about 90 seconds in I get this single sharp stab of pain from the centre of my left breast shooting up to my shoulder and neck - but it goes away so quickly the techs always say 'What, where did it go, did that just happen...'.
Hope it gets resolved soon. I also get the "your heart is fine don't worry" from my GP and the A&E doctors, but I still randomly get MI symptoms without exertion now and then. Only been for an echo which came back fine, so my GP doesn't think it's necessary to be referred back to my cardiologist.
Thank you. Sitting down comfortably is often helpful. My cardiologist does not understand why I have so much angina, given that I have just moderate blockage to two arteries.
I gave up on GTN when I started getting ulcers under my tongue. I’m now on Nicorandil which seems to help but I’m having to keep upping the dose which like you plays havoc with my blood pressure.
My husband is just the same especially in this colder weather - he has to take his gtn spray a lot. But as he says if he went to hospital every time that the gtn did not work then he would be there a great deal. He spoke to his cardiologist and he told him take the spray and then lie down and rest. He is on medication:- diltiazem, candesartan, isosorbide, nicorandil and ranolazine. I worry as his blood pressure goes so low he passes out but when I ask about this they don’t want to change any medication.
I'm sorry to hear that your husband sometimes passes out after using the spray. I generally take my blood pressure before having it. If it's already low, I'm very wary of spraying as I don't want to faint.
I think the spray itself is hard to control. The dose you get depends on how hard you press the top!
I always sit down when I take it and rest for a while afterwards.
Although not exactly the same problems as you but I am also having issues with GTN spray! I have had heart disease for 20 years which has become extremely worse in the past 12 months where I'm waking up in the night with angina. But when I take the GTN spray for the 1st minute or 2 the pain is excruciatingly worse before it finally settles down and eases off. Overall takes about 15 mins. I have called an ambulance 4 times recently and was admitted overnight. None of the Drs can explain this or have even heard of this before?! Luckily while this happened they caught the pain episode on ECG so there is evidence there is something wrong. I am now awaiting heart MRI.
I take the spray before I do anything physical during the day which works ok but im using it up to 12 times a day! but obviously I cant at night! in the meantime I don't know whether to take the spray or not. Oh and my BP and pulse goes through the roof when I take the spray!
Sorry to hear that you're having such a tough time. I hope the cardiac MRI proves helpful.
It seems very odd that the GTN spray causes you pain and increases your BP and pulse levels. I wonder if different meds would be better for you. Other possibilities have been suggested in this thread.
I look forward to hearing about your angiogram. I have microvascular angina and GTN doesn't help me, in fact increases pain. The cardiologist said this is typical for some MVA patients. Well, I may well be a million miles or more off the mark.
It can be trial and error trying to find the right combination of medications that works best for you. You do need to be seen by a Cardiologist who you can establish a good relationship with to achieve this outcome.
Nitrates can be effective for those with vasospastic angina however work less well in those with microvascular dysfunction causing their MVA.
It is as though we all have our own individual version of non obstructive coronary artery disease.
I live with coronary vasospastic angina.
I have vasospasms in my small and large blood vessels microvascular angina and coronary artery spasms.
Thank you for your very helpful reply. I’ve had a quick look at the link and will study it properly later this morning.
I’m seeing my cardiologist in January and will discuss the contents with him. I do wish that routine cardiology appointments were three-monthly rather than annual. Struggling with pain is a lonely business and I could do with a bit more support - as I’m sure could most of us.
Living with pain can be very isolating. Unfortunately there are very few resources for those of us living with chronic pain.
I was referred to an very good pain management programme at University college Hospital in London. You learn to respond to your pain in a different way.
There are quite a few on the forum who live with either MVA and or vasospastic angina, so please don't feel you are alone.
Thank you for your kind reply. My pain isn't severe but it is trying and unpredictable. It has an impact on my life as it makes me anxious about doing things I'd like to do such as going abroad. However perhaps all that will change now that I know about the port!
I was prescribed patches. They possibly helped: perhaps their main benefit was psychological, as it was good to do something!
Since you and I seem to react similarly to GTN, it may be that we have similar disease and that it will be worth my mentioning a few other things that have found beneficial.
Have you tried gentle walking, e.g. just around a room or two? My experience is that this can sometimes help but sometimes harm.
Drugwise, I have found calcium channel inhibitors (amlodipine and diltiazem) beneficial. I take 10mg amlodipine plus 180mg diltiazem, as well as enalapril.
Otherwise, I can only suggest that you try alcohol, e.g. red wine or port, which I think can help. Obviously you can't do this all the time!
May I ask if you are experiencing other things going on apart from chest etc pain?
I very much want to try nitro patches, which till today I hadn't heard of. I haven't heard either of Diltiazam either so will discuss that with my GP. At present my heart medications are Isosorbide Mononitrate, Amlodipine, Bisoprolol and Ranexa.
The heart symptom I have apart from angina is occasional mild breathlessness. I also feel very tired but this may have other causes.
I haven't tried gentle walking though perhaps I should. I tend to sit very quietly and hope for the best. We have an unopened bottle of port so I will try that too!
Thank you for your suggestions, which are much appreciated. I'm now off to watch another parliamentary farce. Can't be too good for the heart.
Would be interested to hear how you get on with the GP about nitro patches. I was prescribed them by my consultant cardiologist who I see privately (long story). The pharmacist at my GP practice said they didn't know what he meant by nitro patches and the prescription had been written incorrectly!
From a Facebook forum I understand they are not often prescribed and are seen as old-fashioned.
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