Newbie here. Have been waiting three years for an appointment with cardiologist to materialise and because of increase in severity of symptoms my GP prescribed nitroglycerin and told me to use it if/when needed, plus take one baby aspirin a day. He described it as a bandaid and was going to try to light a fire under one of the cardiologists (there are now three of them!) that he's referred me to.
My question is, when is nitroglycerin a good idea and when should I just wait it out? It was prescribed in response to an episode which might have been an actual heart attack (but who knows?) quite brief in duration, but I have for some time had relatively frequent moments of breathlessness, discomfort in area of my chest or just below the sternum and sometimes also extending into a toothache. I've not felt quite myself since that episode a couple of weeks ago. In late 2022 an echocardiogram showed I have aortic regurgitation; the other investigations my GP could do were all normal, and his request I have a stress test was denied.
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HeronNS
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Sorry you've also had to head towards the cardiac forums as well.Rule of thumb when you are using GTN spray isn't to wait it out at all.
If you begin to get breathlessness, chest pain or tightness you should take the spray as directed as soon as you can to help prevent the symptoms getting worse.
Take your dose whilst sitting down, preferably with legs raised, or at least in a place were you can have physical support , in case of side effects like lightheadedness, but also so your body is relaxed making it more likely to work.
If after five minutes the symptoms remain or are getting worse you should use the spray again.
If after that symptoms persist or get worse you should seek additional medical help.
There is also guidance for using a GTN spray prior to physical activity , exercise or a big stress activity to prevent the possibility of triggering symptoms and to improve your physical ability.
Advice is to take the spray 5 minutes prior to starting the activity, the next dose could be taken 5-20 minutes into the activity as well if you need it , if you require more during the activity to take it as soon as it's required . The dose lasts about 30 minutes.
For example , you are going for a walk , take it prior to starting , 15 minutes into your walk there is a steeper part of the path that you know causes you symptoms or makes you feel breathless, take it before starting that hill.
One thing that you should do is to get used to using the spray so that you can do so accurately during a rapid onset event.
One thing that will be helpful in your case is if you start using the spray regularly and find that your symptoms daily begin to improve it will help them make a diagnosis when you get to see your Cardiologist.
Hope you get seen soon.
I'm on an endless wait to see my Cardio at the moment and sadly unmedicated for my new symptom of severe activity onset/ labile hypertension because standard medication makes my orthostatic hypotension much worse , particularly at night and the GPs admit they don't feel comfortable trying anything out now as it's really beyond their knowledge . So stuck in a pretty slow and uncomfortable limbo.
Ironically, it's harder to see my reliable cardiologist because he had a heart attack last year!
Thanks. I did use it once, partly to see what it was like, and it made me feel so horrible and terrible headache for some hours, I decided then and there I would only use it if I had the crushing pain again. But doubts about that are what prompted this post.
Yes , headaches can be a side effect but this can actually improve once your body is used to the new medication.Like most medications first few doses can be a bit if a shock to the system but the benefits once you are used to it definitely outweigh the risks.
I certainly wouldn't wait until your pain is so severe before using it , as the pain swing itself can actually be partly responsible for any headache you feel as well.
Last night was interesting. I'd fallen asleep and then a sound woke me up. Opened my eyes and saw a dark shape with glowing eyes on my chest, which I assumed to be a cat, who is not allowed to sleep on me, so went to brush him off, but there was no weight, and I felt nothing as the shape seemed to fall away. That was eerie, must have been a very short lucid dream. However I was then awake and unnerved by this, so turned on the light, got up, went to loo, came back to bed and, of course, felt breathless and as a weight pressed on me thought, d*** I'd better use that spray after all, this doesn't feel good. I drank some water first, then got comfortable and used the spray. I did feel a little bit of pressure in my head, but nothing like last time, and after a while felt a bit better and eventually dropped back to sleep. No more cats, real or hallucinatory, disturbed me. 😸
It's funny how often your brain creates lucid dream that seem to symbolise that you need to wake up because of symptoms beginning. The eerie glow was quite a cool way for your brain to try to explain that you had a pain in your heart,Glad it was easier when you used it , that should continue.
It's actually a good idea to have a drink of water before the spray if you are up to it , I find it seems to work quicker and more efficiently, probably because the moist mouth helps with absorption.
The first time I realized I was really thirsty when it was too late and couldn't have anything to drink for a while. Probably dehydrated which didn't help the headache! Just a new thing to learn and learn to live with. Thanks for your support. ❤️
This is great information. I have exercise induced chest tightness and was never told to use prior to start of exercise and then again during , if needed . Thank you
Oh my Heron. I'm sorry to hear you're going through it again. I don't have any answers, but remain supportive and a good listener. I'm sure you'll get some answers from folks who have experienced similar. I do have a lot of discomfort just at the base of a very tender sternum. I did have a stress done a couple of weeks ago (don't know how I managed to do it, but I did), which was not bad at all. He said my heart rate was a little fast, but I was walking on an incline on the treadmill. This was a the second level. I couldn't do the third level, mainly because of my back. I was on the heart monitor in the ER overnight and a couple of days later, I was fitted for a Holter monitor to wear at home for 24 hours. I'm not sure of the results of that, but the Internist (cardiologist) I saw didn't seem concerned and said he would call me). Hopefully my GP has received a report by now. I do hope you're feeling ok, not becoming anxious (although it would be difficult not to). Hugs.
Thanks. I'm glad you got all the requisite tests. I'd be happier if I didn't seem to have fallen into a referral black hole. It would be nice to know what's really going on. 🤔
I know all too well about the referral black hole. I think I was in it for 3 out of 4 years of PMR. In fact, just recently I got calls for referrals from 2020, referred by my now deceased GP. One was for a brain MRI and the other was to a Neurologist. I'm assuming both about the same thing and I don't even remember what the thing was. I declined both. Ridiculous.
After my stents, there was a phase when I had to use the GTN spray everyday! Confused about whether it was due to stomach pain or chest pain, I found relief using the spray. However when I eventually got my GP to look at it, I was instantly referred to hospital, this led to some tweaking of medications and I no longer needed to use the spray.
If you feel ill and you will know if its a heart attack phone 999 thats what its for they will tell you about your GTN spray and when you took it the once did it work because it subsides your symptoms thats how you know .Sometimes its too late to phone 999 if you are having an HA dont take the risk
I'm sorry you are joining the GTN club I have LVH and Unstable Angina so rely on my spray regularly . I could not tell you anything Blearyeyed has not said she is bangon correct, and I would vigorously agree with her telling you NOT to wait any pain out, go for your spray etc .very best wishes
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