Intravenous or intracoronary injection of nitroglycerin as well as of nifedipine

[DJ3271]

Has anyone had these injections?

pubmed.ncbi.nlm.nih.gov/745...

[Milkfairy Heart Star]

No. It would be too risky and there are no large randomised trials to suggests it is safe or affective.

Nifedipine has been replaced by more effective calcium channel blockers such as Diltiazem, Verapamil and Amlodipine.

The article you have posted is from 1981 which is almost ancient history in the evolution of the knowledge of microvascular and vasospastic angina.

To give intracoronary nitrates/GTN would require having an invasive angiogram. GTN is commonly used to dilate coronary blood vessels if they have gone into spasm during an angiogram.

An angiogram even without acetylcholine can sometimes induce coronary vasospasms.

An invasive angiogram is not a risk free procedure.

When my vasospastic angina is unstable I am treated with high doses of intravenous GTN and IV morphine.

It usually takes several days for my vasospasms to settle.

GTN/nitrates can drop your blood pressure dramatically as well as causing a very severe headache.

My blood pressure is closely monitored when I am on IV GTN for this reason.

Dr Google's consulting room isn't always a reliable source of information.

I will always suggest going to trust worthy well researched up ti date resources such as the BHF and The International Heart Spasms Alliance websites.

The other important source of support is a knowledgeable sympathetic Cardiologist who listens and is able to work with you.

If I could, I would clone my Cardiologist and send him over to you😊

[DJ3271 in reply to Milkfairy]

OMG! It was that old! YIKES! I hope you are having a good day!🥰

[DJ3271 in reply to Milkfairy]

I wish I had your cardiologist! I am telling my hubbie we need to move back to the UK!

[Milkfairy Heart Star in reply to DJ3271]

I am sure you will find a Cardiologist to help you too.

As someone else said you might have to kiss a few toads to find your prince though 😉

[DJ3271 in reply to Milkfairy]

TU! I am seeing a new guy Friday. I am also seeing my old guy Thursday. Cross your fingers for me. I may need to go into the city (Manhattan). Things are so volatile lately, I am afraid to travel anymore.

[Wooodsie in reply to Milkfairy]

Your knowlede never ceases to amaze me 👏👏👏👏😲🤣🤣

[LSCE in reply to Milkfairy]

Hiya Milkfairy, You have been very helpful with advice. I read this latest post with great interest as I'm on Nifedipine. My cardiologist keeps telling me I'm on right treatment but doesn't know cause of my minor heart attacks and symptoms. 2 clear angios', Echo okay and cardiac MRI after first HA but no investigations since . Mention of MVA, spasm but when I asked are we saying this is non obstructive coronary artery disease, he states no we don't know. Now reluctantly referred my to a fellow cardiologist who has an interested in the subject and can perform the diagnostic angio. Only because I mention my contact with research team elsewhere and advice to get referral on to them but GP wouldn't as under cardio and nor will my cardiologist. After first HA, diagnosed by elevated troponin, the severe chest pain, breathless, sweating kept occuring nightly and then episodes every few hours. Seen A&E and Isorbide mononitrate stopped chest pain other than a few episodes for about 5 months severe chest pain restarted, episodes of 5 to 10 minutes, finally seen again A & E no sign obstruction on angio again but elevated troponin, added in CCB Amlodipine, continued episodes, changed to Nifedipine, you state is no longer used. Better on this but had a really severe HA type chest pain Dec 2021 sweating, breathlessness, extreme parlor lasted 10 mins so didn't call 999 then felt dreadful for hours. Told cardiologist not interested did the right thing not seeking help or advice. My concern is recurring episodes leading to heart muscle damage, heart failure. I fear without monitoring will not be picked up early and as my partner states are we waiting for the big one. Sorry to write the long post but just feel cardiologist not listening, can't develop a rapport, he doesn't explain anything, rationale for treatment and decisions. Don't even know why I'm posting this but feel better for having done so.if you have read to the end of post thank you and for a your posts / advice on here much appreciated.

[Milkfairy Heart Star in reply to LSCE]

Hello LSCE,

I am sorry you having such a challenging time.

The NHS Constitution which applies in England allows you to request a second opinion.

A GP or Consultant is professionally duty bound to give you the opportunity to see another specialist.

It might be worth contacting the Patient Advisory Liaison Service, PALS or the GPs Practice Manager to raise your concern that by denying your request to be referred to the St Thomas's research team you are being prevented from taking part in important research.

You will not be able to get an accurate diagnosis and appropriate treatment.

No proactive prevention of possible major adverse cardiac events eg.

heart attacks, stroke, heart failure and admissions for unstable angina.

By refusinfg to refer you, the Cardiologist is obstructing another Cardiologist's research which is unprofessional.

Finally when you do meet the new Cardiologist I suggest you ask them are they able to test for microvascular dysfunction and coronary vasospasms?

Will they be following the BHF NIHR consensus document regarding invasive testing for angina non obstructive coronary arteries ?

If not ask the Cardiologist to refer you to St Thomas's Team.

If they say no, contact PALS.

heart.bmj.com/content/early...

[LSCE in reply to Milkfairy]

Thank you so much for response. I have been very grateful for the immediate intervention and investigations after first HA. I feel like I'm making a fuss so thank you so much for your advice. I'll see how the consultation goes with new cardiologist hopefully he will listen to my concerns and address them. Or at least explain things clearly so I have a better understanding.

[DJ3271]

p.s. thank you for talking to me.🌹

[Dizzy64]

Hello DJ3271,My only experience is with Nifedipine which I take 10mg 3xdaily they work well for me as I have been on them for 7years (2015) even though my symptoms started in 2011 but was only mild but gradually got worse, whereas my hands would be all shades and tingling like mad.

Although I know nothing of the injections you mention, I would be very wary of anything like them.

Sorry I haven't been much help, but having read the other replies I have found it very informative.

I wish you all the best and keep safe.