GTN spray for angina only?

Hi. Might seem like a stupid question but as I’ve had different responses from range of medics GP to cardio nurse I thought I’d ask here!

Brief history - STEMI LAD October 1 stent. Clot in stent 4 hours later. November - ACS - angioplasty and stent RCA. December- angiogram and challenge test - MVD diagnosed. Since March ongoing angina attacks during night and on waking (up to 4 times a night ) - relieved by spray. Increased meds and some additional ones Now have some angina attacks during day on fairly mild exercise - again spray relieves. Recent echo shows EF improvement from 40-45% in November to 60% in March and main arteries clear. Micro vascular angina continues to be diagnosis.

Main question as I’m beginning to feel like a hypochondriac! Does GTN only relieve angina or can it relieve other causes?? I ask because heart now ok but these pains continue and can be very challenging but I know can only be controlled with meds. But it seems that new meds work for a week or so then back to square one

Sorry to moan. I know people on this forum are going through far more!!!

[Milkfairy Heart Star]

Microvascular angina can be difficult to treat and certainly a challenge to live with.

Microvascular angina does and can effect your heart muscle.

There is some evidence to show that people living with Microvascular angina don't respond as well to GTN or become tolerant using it, so overtime the GTN becomes less effective.

How is your Microvascular angina being treated at the moment?

I suggest you contact your Cardiologist and ask for your medication to be reviewed.

"Angina: contemporary diagnosis and management | Heart" heart.bmj.com/content/106/5...

[Hidden in reply to Milkfairy]

Thank you for the information. I’m on a few different meds Haven’t got list with me but as far as I can remember (ignore spelling) - isosorb mono nitrate x 3 per day, clopidogrel, ivabradine x 2, amolpodine, ramipril, ranoxen )?) aspirin and 2 more but can’t remember them at moment! Thank you

[Milkfairy Heart Star in reply to Hidden]

Hello, It may be worth asking your Cardiologist to try some other medications?

It can be a very individualised approach that is needed.

Beta blockers can help Microvascular dysfunction however make vasospasms worse.

Amlodipine is a Calcium channel blocker and there are other options also taking extended release tablets can help.

Ranolazine works for people others not at all. It's a bit of a marmite medication.

Microvascular angina is a complex condition and it needs patience and persistence to get the best combination of medication to suit each individual.

Please do not feel you should just put up with your symptoms.

Kristin has already answered your query about GTN it can relieve the pain due to oesophageal spasms it's not specific to relieving angina.

However you said your angiogram shows you have Microvascular dysfunction which is a cause angina.

[Hidden in reply to Milkfairy]

Thank you for that. Yes I was on Bisoprolol and of course Atorvastatin. However Bisoprolol was stopped by cardiologist because of MVD. Atorvastatin stopped because of elevated liver function test result. Did try stat again 3 months later and half original dosage but my results shot up again after only 5 days. Still not back to normal despite no statins for around 6 weeks. It’s all such a lottery at times but I’ve been luckier than a lot of people on the forum as I’ve had lots of tests and appointments. Just don’t like to bother them again about the angina. I’ll give it a bit longer - can’t face more meds being changed or added at moment. Trouble is I have diverticular disease and usually around 2 or 3 bad bouts of diverticulitis a year that see me hospitalised for 5 days - I have managed to go since last August without a bout and really worry every time meds are changed in case it triggers it 😏. Thank you for the time you take to respond and I will look at links. I have looked at your links in the past about micro vascular angina and they have been insightful

[Hidden in reply to Milkfairy]

Me again. Do you know though if GTN spray only works on angina attacks?

[jerry12953 in reply to Hidden]

I had no idea GTN affects other conditions! I have what is probably MVA and I haven't found that GTN has much effect on it at all, if any..........

[Milkfairy Heart Star in reply to jerry12953]

There is some evidence that GTN doesn't help people living with Microvascular angina while it helps those living with vasospastic angina.

Have you been tested for MVA?

[jerry12953 in reply to Milkfairy]

No, I haven't had the gold standard test but all my scans etc have come back clear (ish). All the circumstantial evidence points that way.

[Milkfairy Heart Star in reply to jerry12953]

I hope you can get a clearer diagnosis soon.It matters.

I was given beta blockers before my diagnosis of vasospastic angina was confirmed. I ended up in CCU.

Beta blockers can help those with Microvascular angina caused by microvascular dysfunction however they make vasospasms worse.

[jerry12953 in reply to Milkfairy]

As yet, fingers crossed, no sign of vasospasms. The pain is solely on exertion. I'm on amlodipine although I've no evidence that it actually makes any difference! I couldn't tolerate bisoprolol.

[thehypnotist in reply to Hidden]

I had my long standing angina diagnosis reversed a few years ago but allowed to keep my GTN spray because it usually relieves my severe chest pain which can be frequent!

[Kristin1812 Heart Star]

A Cardiac rehab nurse explained to me that GTN spray helps reduce angina, by dilating the blood vessels and helping the flow of blood to the heart. But many other body processes, like indigestion, are helped by the increased blood flow, so GTN helping angina cannot specifically be diagnostic of angina alone..I hope that makes sense?

[Hidden in reply to Kristin1812]

It does. Thank you for taking the time to reply.

[Ourdill]

I take another med called "monomil" which is a slow release daily med that is kindof the tablet form of GTN.. It eased my symptoms and the feel for the need of the spray. I went down to half a tablet(can't remember the dose off hand) as I was constantly dizzy like the gtn makes you feel. Spk to your gp about it.. Hope you feel better soon.. Youve had it rough 😳

[Hidden in reply to Ourdill]

Thank you for your reply. I do take 3 mono nitrate tablets a day as well which I imagine are similar to your medication Thank you for sharing that and maybe I need to give increased dosage more time

[Gazzer83]

Hi. Had first HA 18 years ago at age 39. Meds is an on going process. I have lost count of the amount of meds I have been on and had to change because they either stopped working or I had a reaction to it. The cardiologists are used to it as no one set of meds works for everyone. You just need to persist until you get the meds that suit you. One of the greatest meds for me has been soltalol to control my angina and fast AF.Be persistent.

Regards

Gazzer.

[Hidden]

Thank you for that. I haven’t head of soltalol before. Will look into that. Yes I too worry about changes about horrible reaction to Diltiazem which took nearly 2 months to get rid of and required intensive steroids and skin biopsy. On the plus side I now know all the poses for medical photographers 🤪

[Frequentshocker in reply to Hidden]

I agree with the comments that the same drugs don't suit everyone. I had awful allergic reactions to Sotalol! I wasnt doing well in Bisoprolol so they changed it to Sotalol and the allegy started v soon after taking it but I was in hospital at the time and was monitored. They are supposed to supervise for 5 days. I was discharged on 2nd day and during an allergic attack at home I had a bad fall (breaking my foot in the process!) If trying something new like Sotalol ask what plan B is should you get a similar reaction! They will likely say persist until it settles down but if it doesnt settle you need to know whether to go straight back on your previous meds. Its very much a juggling act to get it right. Im now on Quinedine which is the best so far but not without its side effects too. Its stopped so many defibrillator shocks although on the occasions I get them Im usually fully conscious all through, which isnt pleasant!

[Hidden in reply to Frequentshocker]

Thank you for reply. It certainly is a lottery it seems to me !

[Cookie2020]

Try not to worry to much as this can add to your symptoms.It took me over six years to get my medication right with the cardiologist and his team so stick at it and you will get there 👍

Good luck Andy

[Hidden in reply to Cookie2020]

Thank so much for reply. I’m taking on board everything that has been said. I will persist and hopefully find right combination - sound like a safe cracker 😱🤪. Mind you this is probably just as difficult 😛