Using GTN spray in a preventative manner

[Heartattackvictim]

QUESTION

Has anyone any experience of using their GTN spray before exercise that they can share?

CONTEXT

My issue is that when hill walking I have experienced bad spasms on the descent and against the wind. I'm fine going uphill. It's almost bizarre. The GTN does solve the problem on the descent when I get the spasms. For those interested the picture shows my ascent up Wetherlam, across to Swirl How, and the descent from The Old Man of Coniston when my spasms started. It was a walk of about 13km in 4 hours 30 minutes (but lots of rests making it an 8 hour expedition).

I'm also fine when jogging (5km Parkrun in 35 minutes) and cycling (about 30 miles in 3 hours - generally on the flat).

Many thanks, John

[CrispAddict]

Hi,I had a triple heart bypass two years ago and was a keen cyclist before that. I do still get some angina symptoms when cycling hard or uphill and the same for walking. I have been told by my doctor that it is ok to use my GTN spray as a preventive measure before starting an exercise likely cause discomfort. I generally take one spray before setting off and although the effects tend to wear off after about half an hour I can generally carry on once 'warmed up'.

[Heartattackvictim in reply to CrispAddict]

Thanks. I know the leaflet says its OK to use GTN before exercise so thanks for sharing your experience.

[Milkfairy Heart Star]

Hello,When you say spasms, have you had testing to say you have Vasospastic angina?

I have Vasospastic angina. I usually have a good exercise tolerance, however I will start getting chest pain after physical exertion.

Sometimes it can be delayed for hours afterwards.

My blood vessels can dilate, however they over constrict and go into spasms during the resting phase.

I walked up Haystacks, my chest pain started later at rest. The more I push myself the more chest pain I'll get as a result afterwards.

I sailed through my stress echo, then got chest pain about 10 minutes later.

My blood vessels can dilate, however they over constrict and go into spasms afterwards in the resting phase.

Vasospastic angina is truly a bizarre condition 🙅‍♀️

[Bullsrlfc in reply to Milkfairy]

Hello Milkfairy. I'm fascinated by the description of your symptoms because I've not come across this in other posts but it is very similar to my own experience ie generally ok during exercise (including short runs etc.) but have symptoms some hours afterwards which sometimes continue, off and on, for days. My cardiologist says my symptoms are 'atypical', and even said they didn't make any physiological sense at one point, but has never mentioned vasospastic angina to me (just 'normal' angina). What sort of treatment have you been offered for this? I have the usual cocktail of Ramopril, amlodopene, statin, asprin, bisoprolol and ticagrelor (I had 3 stents fitted last year). Thank you

[Milkfairy Heart Star in reply to Bullsrlfc]

Hello,

A former term to describe vasospastic angina was variant angina.

I have listed my medication in answer to Heartattackvictim.

Have you asked your Cardiologist to consider whether microvascular dysfunction or coronary vasospasms are the cause of your symptoms?

Another umbrella term used is Ischaemia/ Angina non obstructive coronary arteries.

INOCA/ ANOCA.

It's an emerging area of interest in Cardiology however sadly too few Cardiologists truly understand these types of angina.

[Heartattackvictim in reply to Milkfairy]

My consultant has written that the "differential diagnosis is either microvascular coronary artery disease or coronary artery spasm". I'm on Monomil and Ranozaline to help deal with the spasms (plus ramipril, statin, ticagrelor, aspirin).

[Milkfairy Heart Star in reply to Heartattackvictim]

Have you asked for further testing to determine whether you have microvascular dysfunction or coronary vasospasms?

The treatment options are different.

Eg. Beta blockers can help patients with microvascular angina but can make coronary vasospasms worse.

Nitrates seem not to work so well if you have microvascular angina.

Calcium channel blockers are usually prescribed to treat coronary vasospasms.

I am on top doses of Diltiazem, Nicorandil, Isosorbide mononitrate, s statin, GTN patches.

Clopidogrel rather than aspirin, as aspirin can be an issue if you have coronary vasospasms.

I don't use GTN spray as it works, then makes my rebound coronary vasospasms worse.

Ranolazine is interesting it either works or doesn't.

Again tends to be more useful for patients with microvascular angina.

The problem we face as patients is that so few Cardiologists have an indepth knowledge about microvascular and vasospastic angina.

It has slowly improved over the years since I was diagnosed.

[Heartattackvictim in reply to Milkfairy]

Thanks for your reply. As I'm on the slow release snitrates too I wonder if you also use the spray?

[Milkfairy Heart Star in reply to Heartattackvictim]

I don't use GTN spray as it works, then I get worse rebound coronary vasospasms.I use nitrate patches instead. They work faster than slow release tablets but not as fast as short acting nitrates such as the spray.

Perhaps discuss this with your Cardiologist to see if the patches might help you.