I am 78, male and have multiple health problems including asthma, COPD, diabetes, Barrett’s oesophagus, and osteoporosis. The most life threatening condition, however, is rapid resentosis in coronary artery stents. This first stents were inserted in November 2020, and restenosis started in December of that year. Further stenting was done in February 2021, followed by insertion of a TAVI. Again restenosis started within two months, and by June 2021, there was 90% blockage. This time, the stents were straightened and scraped, no new stens were inserted, and this significantly improved my condition. However, they told me at that time, that they would not be able the repeat what was a “vert tricky procedure” because of the presence of the TAVI. I got about 8 months of reasonable health following this, but now I am as bad, or worse than i was in June of last year. I have had a private appointment with the doctor who did the ”tricky PCI” work, and he has agreed to have another go. He has put me on the NHS waiting list and also said that he can do the procedure privately. However, he is on holiday for two weeks.
I am on almost maximum isosorbides, and also Relenka, but am getting worse by the day. I have angina attacks several times a day. I try to avoid using GTN sprays unless these do not clear fairly quickly, as I understand that the effectiveness of these reduces, the greater the usage. I can walk only very short distances. I feel ill most of the time.
My only option, other than suffering at home, and possible dying of a heart attack is to call 999, but this is not very appealing, with likely waits of several hours before arrival, possibly 12 hours or more in the ambulance outside hospital and/or similar times lying on a trolley in a corridor, several days waiting for a bed in a cardiac ward, and then it is not clear to me what can be done to relieve my symptoms while waiting for the PCI procedure. (my very limited lung function precludes open heart surgery)
Even if I can get to talk to my GP, I don’t see that there is anything they can do.
My practical advice question is whether I should use the GTN spras anytime the angina occurs, or should I continue to delay until the pain is very severe and not going away?
I also wonder what other people would do in my circumstances – stay at home and wait either for an appointment for the PCI procedure, or die first, or else call 999 next time I get a bad angina attack.
Written by
epzcaw22
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Hello I am not sure I can help but can see you are in a a very difficult situation with your health, and didn’t want to read and run. If your getting angina on exertion and it is unbearable and feels so severe then perhaps the GTN spray is the answer. BUT you know your body if the pain is so severe especially at rest then don’t hesitate to call 999 whatever the wait and issues, i sympathise that it isn’t an appealing option but better safe than sorry.
Hope you find a solution, dying should not be one of your considered options. ❤️
Thank for your interest and reply. But I am not convinced that going to hospital, especially with the appalling process that this has become, will be of any benefit, an dmay be mire damaging than jsut staying at home.
"My only option, other than suffering at home, and possible dying of a heart attack..."
I wonder if you've fallen into the trap of assuming there's a clear relationship between stenosis and heart attacks?
The reality is that over half of heart attacks occur in people with less than 50% stenosis, a level that's so low it's not that easy to detect or measure.
Conversely there are plenty of people on this forum, myself included, who had high levels of stenosis, well over 90% in some cases, but have never had a heart attack.
There's no question but that your stenosis has left you with serious angina, but serious angina (as long as it isn't unstable angina) isn't a particularly strong indicator of imminent heart attack.
You should consult with your GP, but when I was given a GTN I was told to use it whenever necessary, there was no suggestion of abstaining to maintain effectiveness.
Thank you for your reply. The last two times I was admitted to hospital, I was found to have raised Troponin levels and my notes record as an “Acute non-ST segment elevation myocardial infarction", so i'm failry sure that without treatment, I will end up with another such episode. The angina comes on with little or no exertion - most mornings , it starts as soom as I sit up in bed. I can do very little now. I can walk maybe 20 yards when I am at my best, and no distance at all when I am bad.
I saw a junior registrar at a hospital appointment, and asked about use of the GTN spray, but he was not able to give a clear answer, so I don't imagine a GP will do any better.
Thanks for this. However this article - bhf.org.uk/informationsuppo... from the British heart Foundation says "You can use your GTN spray preventatively if you know an activity will bring on your angina, but be aware of how often you are using it, as overuse can reduce its effectiveness."
Interesting, but here's an NHS article that gives a slightly different slant, implying that any reduction in effectiveness can be compensated by heavier usage/prescription for a stronger dose.
I live with vasospastic angina which can become unstable. GTN is an important medication in my armoury.
Chappychap has given you some good advice. Don't be shy about using your GTN spray.
It's a short acting form of GTN which means it doesn't become less effective over time.
I suggest you use it at the beginning of your chest pain rather than waiting until the angina gets too much.
The usual advice given is, that if you need to use the spray 3 times, 5 minutes apart in a row or if you experience chest pain at rest or resting doesn't ease your chest pain, it's time to ring 999.
Please don't wait at home for your appointment or PCI. Call 999 and go to hospital. There are other treatments that you can be offered.
It's also important for the doctors to check your heart is okay.
I don't like going into hospital either. I end up in hospital once or twice a year.
I was last admitted in May. I didn't wait for hours and was treated as quickly as possible. I had to wait about 6 hours for a bed. It wasn't too bad as the A&E staff started my IV GTN and gave me pain relief.
Thanks for this. However this article - bhf.org.uk/informationsuppo... from the British heart Foundation says "You can use your GTN spray preventatively if you know an activity will bring on your angina, but be aware of how often you are using it, as overuse can reduce its effectiveness."
Well as usual Milk Fairy has it. Follow her advice. I was about to ask what they could do in the hospital, and maybe waiting until the cardiac surgeon returns from hospital would be a food option, I must stress that I am not in any way experienced or qualified to advise. But my position would be to try and see the same surgeon or you may be taken down another route, as they all seem to have their own preferences. This might be a good thing though??
I'm sorry to hear you are so poorly, like the others say, use the GTN spray and if there is no improvement, you may be better in the que than not in the que.
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