GTN Spray Advice

Hi Elizabeth, I tend to use mine when the pain comes sometimes the spray works and when it doesn't (no relief from using the spray 2x2 sprays) I go to hospital or dial 111 which usually sends ambulance. Side effects can be troublesome, I believe it's a common issue amongst users. Trouble is doctors/consultants never explain things thoroughly and if you're like me I always forget to ask at the time. 

 

Hi Ruby, so true, its when you get home you realise all the things you should have asked, she certainly never told me the spray can have such an effect, do you spray if the pain is not too bad or do you wait till it's really bad, and do you get pains or tingling in your hands and arms, is that when you ring 111.?   sorry to sound rather dumb, but I am in such a quandry about it all.

Hi Ruby Red,

Have you tried the universal GTN resume, or even the old resume ?. The new resume is one spray every 5 minutes and if no relief after 4 sprays (20 minute period) then an ambulance should be called.

The old resume was 1 spray to start then if pain persisted after 5 minutes take 2 sprays, if after 5 minutes pain is still there take 3 sprays then again if after 5 minutes the pain is still there have 4 sprays, If pain is still there after the 4 sprays then ambulance should be called, I was told why they stopped the old resume of spraying GTN but I have forgotten but I still use the old resume as I'm a frequent flyer with the ambulance and our ER Department.

I find paracetamol does nothing for me chest pain wise, only gets rid of the GTN head ache if I get one. People usually have the spray when they feel a niggle coming on, when used like that you have more of a chance of getting on top of it rather than leaving it until it's more than a niggle and then you end up having a hard time in getting rid of it.

Hi Samuels.....

The new gtn resume sounds better for me (easier to remember!), I am having spasm at the moment on/off since yesterday and it's worrying me, waking me up last night, Gtn helping but not getting rid of it so to speak. I know I said I usually go A&E but have lost confidence this time because of the stroke/migraine episode (in other discussion) and paramedics were out to me last week & not happy, although one said there were signs of Sinus?? on ecg....I was left aaand still alive!!

I was taking paracetamol before to get rid of the gtn headache, but as now got naproxen for hemiplegic migraine, wondered if I could still take the paracetamol with it too.

Hi Elizabeth, I usually spray soon as the pain starts and it 'usually' does the trick, although I am having trouble getting it under control at the moment and the spasms are waking me up, which isn't a good sign as far as gtn treatment goes. When I've gone into hospital with this problem I usually have a gtn infusion which sorts it, so I'm assuming that's in a stronger form other than the spray, it has to be monitored whilst they increase the infusion (dose) as it can lower blood pressure quite significantly, so the nurse always says.

Normally I get a dull ache/pain under my left arm, and the chest pain I can feel like a crawling round my left side to my back, neck, and chest pressure.

Trouble is because of my history, 111 usually send ambulance/paramedics anyway same as if I go GP, particularly where chest pain/angina is concerned.

Hi RubyRed,

Sorry I can't help you with the naproxen question.

I fully understand your worry about paramedics and Emergency doctors, I've been there and done that, got it all sorted, I occassionally get a couple of arrogant paramedics and young doctors,I have the doctors sorted out, here about 2 months ago I had an emergency doctor give me the riot actand he told me to my face that I was clogging emergency department up...I saw red after that and I laid a formal complaint and all seems to be good now,I swear some of the doctors don't read what our cardiologists have written down in our records. Some doctors have even said to me that they are refusing pain relief because it only masks the problem, My answer to them is of course it only masks the problem because there is no cure for prinzmetal angina and I'm only here under other senior doctors advice and my GP's when I can't get rid of the pain.

The Paramedics, the majority of them are aware of prinzmetal angina and are sympathetic but there are around about 6 that really give it to me and they are on notice, if I get one of the crew that gives me grief again I will be lodging another formal complaint to our ambulance service, I understand that they are under a lot of pressure and have everyday stresses dealing with death and abusive patients but to me it's still not an exscuse to take their frustrations out on people like us, we can't help that our condition is uncurable or sometimess doesn't respond to treatment or even being a hereditary condition.

If there was some sinus rythm detected the Paramedics should of taken you to Emergency to get it checked out especially if you have a known heart condition.

Don't let the emergency doctors get you down, if you feel you are being treated unfairly or not receiving the appropriate care perhaps lodge a complaint and get it sorted, as I said above, I had to and now I'm being treated with some respect now and pain relief is now always offered, our hospital here take complaints seriously and investigate thoroughly, they consult all that involved with your condition with in the hospital, I.E  cardiologists right down the line to the nursing staff, but the nursing staff aren't the problem here where I am, they are an excellent lot of people, very professional and have an understanding of my condition, although there is one old grumpy sister but I soon put her in her place,she needs to practice what she preaches.

If you are still suffering the chest pains now I'd be calling an ambulance to go to emergency... As the doctor told me on Sunday just gone there's going to be a time when I don't call an ambulance and that maybe the time I really need them, very good emergency doctor this lady was, I have several of the senior doctors say the same thing.

I wouldn't mind so much Samuels but it was 111 that sent the paramedics last week, I spoke to a health advisor there who put me on to a clinician. Both very polite, but wanted me assessed by paramedics.

I find a mixed bag when dealing with medical professionals some of the nurses can't do enough for you and others are so rude they need more training in attitude/communication. 

I'm feeling very sick at the moment aswell, not well at all, but it's very hot here and I do not cope very well with the heat (heatwave next couple of days).

Yes.... Extreme heat and cold weather are known triggers for Angina, It's winter here and a cold day or a cold whisp of wind to the face is enough to trigger an angina attack. I even had one ED doctor tell me that he'd never heard of cold weather triggering off angina, he was the one I reported, I told him I suggest you hit the books again and do some more research into triggers of angina.

Have you been diagnosed with angina or some other heart condition ?. GTN infusions, they stopped that with me a couple of years ago,it was taking to long to get rid of those symptoms you just described, I don't know why they stopped,perhaps it could be because I have developed an immunity to GTN or because it's only coronary artery/ blood vessel spasms.. I honestly don't know. Morphine or endone is now the norm for getting my pain sorted as there's not a lot they can do for spasms, especially when my troponins come back negative, over the last  3 years I've had 3-4 positive troponins, been told they were NSTEMI's (mild heart attacks) no great changes in ECG over those years, certainly nothing to suggest a heart attack on first look, that's why they tell me to keep going back because of it only being picked up in the troponin test...A rock stuck in a hard place, very frustrating.

Hi Samuels, I have heart disease in my distal arteries Microvascular Disease (diagnosed at our main heart hospital here, Papworth Hospital), angina coronary artery vasospam - spasms can be quite dangerous I believe and can cause MI.

I had small heart attack (although debatable) last year my troponin level was raised at second blood test (one blood test on admittance not showing, I collapsed on emergency ward and had blood test 6hrs later where it showed raised) up to and including troponin level 14 cut off here for MI I believe. However kept in hospital, had angiogram 2 weeks later which didn't show narrowing or damage so I think this is why it's debatable. A very big question mark is that distal arteries, as they are so small do not show up on an angiogram, so NSTEMI here on discharge notes. Severe coronary vasospasm can also cause raised troponins I also discovered.

Trouble is I don't feel I know precisely what the issues are here, don't think docs know either. I'm shrouded by persistent health issues and solid diagnosis needs concrete evidence, too many grey areas hence too many possibilities.

 

Hi RubyRed,

Here's what my Cardiologist explained to me years ago, at that stage I hade pristine conditioned coronary arteries,however I have excessively high cholestrol and believe it or not the Lab and all the cardiologists involved can't work out if it's the good or bad cholestrol, My Triglycerides were also extremely high so I had all the tests under the sun. Finally after all the tests were negative for anything serious the Professor went on to explain to me that what was happening was the small blood vessels in the heart were going into severe spasms,as you stated the Professor said the same thing, these blood vessels cannot be seen by any heart tests including Angiogram, these vessels are naked to the eye, I was told there is no harm occurring when these spasms come and it's something I will have to learn to live with.

Spasms were getting worse as the years went on so Professor performed another Angiogram with the same results and another stress test which also came back normal( I was diagnosed by an emergency doctor as having Prinzmetal Angina),Professor did prescribe GTN Spray which did help. Now back in 2012 chest pains were getting severe and I delayed going to our emergency department, my mother kept telling me I looked really unwell, I did feel unwell but I also had a touch of indigestion and I ignored it, come late that afternoon I called an ambulance and taken to our ED, ECG was normal so I was placed out in the waiting room while they awaited the results of my troponins, the tests arrived back and the nurse came out into the waiting room and told me to follow her,as soon as I arrived into a cubicle and on the bed the doctors came over and said I had suffered a mild heart attack at some stage during the day, repeat troponins were repeated several times until they reached their peak and they could see it coming back down, Next day I was taken down to the Cath lab for an angiogram, Was informed that my right coronary artery was 50-60% blocked (baby blockage) That incident was recorded as an NSTEMI and I was put on a few anti anginal medications, did improve the spasms for awhile but they did return, back in 2013 I had another troponin rise and admitted for a few days then released when I was feeling better,that was also recorded as another NSTEMI,then about 6 months later I was told I had a TIA and spent a week in the stroke unit, 2014 I had another troponin rise and a couple of days in hospital, NSTEMI recorded again although this one I think had a question mark next to it. March this year I had another one and I felt like utter crap and our ED had on just switched over to the new high sensitivity troponin essay at the begining of this year and my levels usually sit around 8 -10, As I said around march, one day I was feeling like utter crap and my troponins came back at 14 but they sent me home, the nurse had said to me "no wonder you feel like crap" I asked her what the cut off was and she was about to answer but the doctor butted in and said 15 was, I did some research and had found out that <14 is the cut off point, so to this day i'm still wondering.

i have been diagnosed with confidence that i have prinzmetal angina but as per the blood vessel spasms there is not much anyone can do other than finding the right balance in their anti angina medication, we found mine in cardizem (diltiazem) 480 mg a day, that really helped a lot but i still get clusters of the spasms, according to my cardiologists spasms are not life threatening, however because i can't tolerate statins and having so called cholestrol problems they have to keep an eye on me.

in saying all that, when i had a tropinin rise last december i had a different cardiologist, he works closely with both mine ( i have 2) and he went into great detail and in laymens terms in explaining what was going on, what's happening in my case is because of my cholestrol and triglycerides being high it's robbing the nitric oxide from the endothelium which is then causing both the coronary arteries and the naked to the eye blood vessels  to go into spasms, as well as having mild heart disease, they are more concerned about reversing the heart disease than the vaso spasms, their treatment wouldn't of worked because as i said i can't tolerate any of the statins, my diet is pretty good, has been for years, although i'm allowed a few spoilies once a fortnight is="" the="" cut="" off="" point,="" so="" to="" this="" day="" i'm="" still="" wondering.="" i="" have="" been="" diagnosed="" with="" confidence="" that="" i="" have="" prinzmetal="" angina="" but="" as="" per="" the="" blood="" vessel="" spasms="" there="" is="" not="" much="" anyone="" can="" do="" other="" than="" finding="" the="" right="" balance="" in="" their="" anti="" angina="" medication,="" we="" found="" mine="" in="" cardizem="" (diltiazem)="" 480="" mg="" a="" day,="" that="" really="" helped="" a="" lot="" but="" i="" still="" get="" clusters="" of="" the="" spasms,="" according="" to="" my="" cardiologists="" spasms="" are="" not="" life="" threatening,="" however="" because="" i="" can't="" tolerate="" statins="" and="" having="" so="" called="" cholestrol="" problems="" they="" have="" to="" keep="" an="" eye="" on="" me.="" in="" saying="" all="" that,="" when="" i="" had="" a="" tropinin="" rise="" last="" december="" i="" had="" a="" different="" cardiologist,="" he="" works="" closely="" with="" both="" mine="" (="" i="" have="" 2)="" and="" he="" went="" into="" great="" detail="" and="" in="" laymens="" terms="" in="" explaining="" what="" was="" going="" on,="" what's="" happening="" in="" my="" case="" is="" because="" of="" my="" cholestrol="" and="" triglycerides="" being="" high="" it's="" robbing="" the="" nitric="" oxide="" from="" the="" endothelium="" which="" is="" then="" causing="" both="" the="" coronary="" arteries="" and="" the="" naked="" to="" the="" eye="" blood="" vessels ="" to="" go="" into="" spasms,="" as="" well="" as="" having="" mild="" heart="" disease,="" they="" are="" more="" concerned="" about="" reversing="" the="" heart="" disease="" than="" the="" vaso="" spasms,="" their="" treatment="" wouldn't="" of="" worked="" because="" as="" i="" said="" i="" can't="" tolerate="" any="" of="" the="" statins,="" my="" diet="" is="" pretty="" good,="" has="" been="" for="" years,="" although="" i'm="" allowed="" a="" few="" spoilies="" once="" a="" fortnight="">

i have been diagnosed with confidence that i have prinzmetal angina but as per the blood vessel spasms there is not much anyone can do other than finding the right balance in their anti angina medication, we found mine in cardizem (diltiazem) 480 mg a day, that really helped a lot but i still get clusters of the spasms, according to my cardiologists spasms are not life threatening, however because i can't tolerate statins and having so called cholestrol problems they have to keep an eye on me.

in saying all that, when i had a tropinin rise last december i had a different cardiologist, he works closely with both mine ( i have 2) and he went into great detail and in laymens terms in explaining what was going on, what's happening in my case is because of my cholestrol and triglycerides being high it's robbing the nitric oxide from the endothelium which is then causing both the coronary arteries and the naked to the eye blood vessels  to go into spasms, as well as having mild heart disease, they are more concerned about reversing the heart disease than the vaso spasms, their treatment wouldn't of worked because as i said i can't tolerate any of the statins, my diet is pretty good, has been for years, although i'm allowed a few spoilies once a fortnight >

Sorry about the rather long post, but it's boring here at the moment,the wind is here and it's raining and cold outside, normally I'd be out in the garage working this time of the night but I don't venture outside any more during winter as I don't want to be in emergency 2-3 times a week again...

My goodness me Samuels you do have a lot on your plate, I don't know what i'm moaning about nowhere near as bad as that,, they say I have three semi blocked arteries to the heart one more than the other and  I get pain in chest and back of head on left side, through you I now know to use my spray more often, I thank you for that. I had heard that difference in weather can have an adverse effect whith heart problems. wherever you are weather wise does nt sound too condusive for someone with your condition,  good luck.

Samuels, don't worry about the long post, very interesting and informative - I'm also very sorry for what you have been through, and wish you only the best.

With regard to my spasm experience, although I am diagnosed with coronary artery spasm,angina, what one consultant has explained to me is that the artery spasm although isn't dangerous in itself.....can lead to heart spasm which is dangerous, where the whole heart spasms which is what I believe happened to me, this can cause so much trauma to the heart and brain, that it is possible to bring about a heart attack not necessarily with permanent damage or stenosis. There is no significant stenosis in my microvascular arteries even though there is atheroma, I think there is another cause, issue here and they're not spotting it.

I'm quite active, not overweight, have quite a good diet, balanced I think and yet I am a deathly grey in facial appearance, I actually look in the mirror and think crikey how am I still alive looking like that!!! I'm not getting enough oxygenated blood circulation for some reason I don't know what's going on. 

 

Hi RubyRed,

Yes I can see where you are coming from, the other cardiologist that I mentioned in my long post, he works closely with my other 2 cardiologists and I'm pretty sure he said the exact same thing as you have just stated that your specialist had said, I believe he has set at least one of my cardiologists straight, My other cardiologist doesn't work for the Public hospital anymore, he works for a private hospital and has his own practice in the private hospitals building, I can see him when I want as he bulk bills me, I go to see him when my cardiologist that he referred me to starts changing things, once he tried to halve my medication and boy did that make things worse but Professor sorted him out ,when he referred me he did say to watch out because the new cardiologist would be a bit green behind the ears and bit of a cowboy and want to perform all the tests again, the cardiologist that he referred me to took over the Professors job in the public hospital as head cardiologist.

To be totally honest I'm a bit over weight,the doctors call it morbidly obese but coming in at 125 Kg's I wouldn't consider that morbidly obese, my partner looks after my meals and I eat the right things but as I said I'm allowed a spoily every fortnight, On the exercise front I'm active but not like I use to be, It's more like pottering around active, house work active and all out doors work active and doing what I like best , working on cars but these spasms at times prevent me from doing these on bad days.When I have my angina attacks I go that colour as well, Grey,nota good look is it.

That's probably why I've had 3-4 NSTEMI's because your description of symptoms are so close to mine but I have atherosclerosis only in the right coronary artery.

Wishing you all the best this end and hope they can help you more, Since my Cardizem ( Diltiazem) increase that has made a huge difference in my spasms, I still get them  and I was told I would but the frequency is nowhere near what they use to be.