Aortic Stenosis & GTN Spray

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Any advice welcome! My 82 year old grandmother has been admitted to hospital on so many occasions due to angina attacks which are not settling after the use of GTN spray. However, they has only ever been 2 diagnosed heart attacks. She has used GTN in both tablet and spray forms for years however it seems to be failing now. I read on the leaflet which comes with the spray that it should NOT be used for people who suffer from aortic stenosis, and wonder if this could be exassebating the problem causing her to be admitted to hospital only to be sent out within 24 hours!

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  • Posted

    Hi Bex,

    Is your Grandmother on any other anti anginal medication ? People that us GTN spray frequently can actually build up an immunity to it and at times can be of no value. the first 2-6 sprays help reduce my Prinzmetal  Angina attacks but on a bad day I can have up to 20+ with no relief "apparently" I have built up an immunity , I have been told to keep it with me at times because it will work ,

    As for  aortic stenosis I can't help you there...Sorry

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    • Posted

      Thank your for your reply, yes she is, she takes isosorbide monotitrate also but beginning to wonder if the GTN is beginning to do more harm than good as also read that it can cause a surge of high blood pressure causing more chest pain. Thinking a chat with her GP maybe in order...
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    • Posted

      Yes sounds like a good idea, having a chat with her GP. I'm also on  isosorbide monotitrate as well as Nicorandil and I've been told that if you are on long acting nitrates and use GTN quite regularly that GTN actually can be ineffective. I use to use up to as I said 20 sprays but have had over 40 in one attack, it just loses it's efficacy, it may help albeit for a minute if I'm lucky. I have had an increase in one of my other medications and I don't have to use the GTN much anymore, I do on a bad day but after the 6 sprays...nothing,zip, very little if any relief.
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    • Posted

      Hi i had a heart attack 3 years ago and had 2 stents fitted,the surgeon asked me during the operation how long i had suffered with angina and i replied that it was news to me as i had never suffered and did not know what the symptoms of angina were,i am now starting to suffer with all the symptoms that go with angina,i have never used my gtn spray i just go with the flow until it subsides. can you tell me how you felt.after the very first spray you ever took and did it work for you?

       

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    • Posted

      Hi frank,

      ​Very first time I used GTN I had a massive headache,almost to the stage where it throbbed smile The GTN worked first couple of sprays with me, all Angina symptoms dis-appeaeared, It still does work but I get these  clusters where after about 10 sparays it just does nothing, I've been told that we can get immune to these nitrate drugs , especially the spray if it's used a lot on a daily basis, in my case that did happen, but things settled down. Come winter time  I have more attacks, Summer time if we have extreme heat that can bring them on too, the medications that I found to help the most were Nicorandil and a high dosage of Cardizem (Diltiazem) , Cardiologist said that it would lessen the frequency of the attacks but it won't stop the attacks if you know what I mean,I don't know it's hard to explain smile the medication is there to help but it doesn't stop attacks.. best way I can describe it

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    • Posted

      Ohhh and the headaches can be lessened with Panadol/Panamax,something similar to that depending where you live, your body should accept the spray with out headaches after 2-7 days, everone is different.
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    • Posted

      I did make a comment prior to this one but for some reason it has to be moderated before it can be posted up, not sure why, nothing out of place with it, It was the answer to your question.
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  • Posted

    I use the tablets with ranitidine to ward off the problem as admitted twice after a cardiac arrest, then someone has suggested the microvascular.They could be right.

    I too have had angina, not recognised, as when I had the heart attack they did an angioplasty .Now they have  never recorded  the spasms in the chest & elsewhere. NB Also taking a statin .

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    • Posted

      Hi Julie, realise this is an old thread but I'm a 34m who was admitted to hospital and diagnosed with s NSTEMI caused by prinzmental agina.

      I am on clopiogrel 75mg, diliztem 90mg in the morning and, one in the evening and GTN Spray.

      I was having a lot of regular "burning feeling" in my chest which they've put down to potential gastro issues caused by the clopiogrel. I am curious why you took:take it?

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    • Posted

      Hi nima,

      I had to have a bit of a giggle, not at you but I'm glad you commented today because my cardiologist is trying to tell me that prinzmetal doesn't cause NSTEMI's, I've had 2 myself and both with that burning, indigestion feeling. all my attacks are exactly the same, there is no way for me to tell the difference so I have to go to our emergency department for the troponin blood test, as NSTEMI's don't show up on an ECG, well that's what I was told but then I had a paramedic tell me that he can read an ECG and tell if an NTEMI was occuring, he says it's all in experience of how to read an ECG, if that was the case there must be a lot of incompetent doctors around smile what do you think ?  They say ECG's pick up all prinzmetal angina attacks yet  some cardiologists have said to me that they don't always, you can be having an attack and an ECG can be showing everything is normal.

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    • Posted

      Hey Samuels,

      Well not sure what part of the world you're in but I'd suggest you swap doctors! That said, it was only through the MRI they noticed the damage to my heart and the angiogram showed narrowed arteries which then expanded during the test itself when given the GTN spray that lead them to diagnose me with having had an MI/NSTEMI as a cause of P. angina. But the ECG from ambulance to discharge showed nada...so I'm not too sure if there are "horse whispers" of ECGs out there wink

      If I understand you correctly you've had some angina attacks but nothing to suggest you've had any damage to your heart (e.g. Your P. Angina has not caused a heat attack?).

      Are you on meds now? If so do you take the GTN spray for the burning/indigestion type feeling - because I don't know when it's heartburn and when it's my angina - reason being before I had to go to hospital I never had angina nor did I have heart burn.

      That's why I say I actually worse now :-/ than when I was in hospital the couple of days I was brought in!

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    • Posted

      Also I would say to your cardiologist... surely depriving your heart of oxygen (which is what a coronary spasm/ P.angina does) surely you can have an MI! Sounds like he doesn't know what he's talking about mate

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    • Posted

      Hi nima,

      I'm on the highest possible doses of anti angina medications, Cardizem, Nicorandil ( Ikorel ), monodur, perhexiline ( this medication actually helped a little ) aspirin, GTN spray and nexium.

      My prinzmetal acts up on a very regular basis, at the moment I am under sever emotional stress and that is triggering it, we have recently come out of winter and the cold was also triggering it, I am in there at least once a week but lately due to the stress I'm in there up to 3 times a week now. They have told me they can see the old heart attack in the ECG but it doesn't always show up on the ECG's, now also according to doctors NSTEMI's there is damage but just not as severe as an MI and that the heart like our liver can repair itself after an NSTEMI. I have a couple of minor blockages 60 % in the RCA and 50 % in the LAD.

      when I use my GTN it will usually clear it up, there's always that  one attack it won't stop when it's at it's worst, I can have up to 16 sprays before calling for an ambulance, my body is immune to all the medications, the GTN doesn't even alter my blood pressure anymore. Now here's an interesting fact for you, did you know GTN is used in the treatment of reflux / heartburn, just that doctors won't tell you that, my GP told me this years ago because I suffer from reflux, have done since a teenager and nothing has ever been found, he said that the GTN will help with the reflux as well , Nexium keeps my reflux in check except for when I forget to take it or I have a PM attack, see I am in the same boat, since my NSTEMI's even with the burning feeling I cannot differentiate either, it's impossible to without that blood test, the troponin blood test, for me it is embarrassing being in our emergency department all the time.

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    • Posted

      That's my thoughts as well smile I have had 2 and a half cardiologist tell me that I have PM angina , one cardiologist actually explained it very well and in laymens terms to me, he was saying because of my weird lipid profile what was happening was that the cholesterol was eating up / absorbing the nitric oxide in my endothelium where the nitric oxide is produced and because the lack of it, it was sending my areteries into spasms. Now I said  two and a half cardiologists, reason being for that is because my original cardiologist who no longer works in the public health system, and also semi retired, I asked him if he agreed with the diagnosis of PM angina, he said  " in theory yes but in practise no "

      Occassionally I have had paramedics tell me that they have seen the spasms on the monitors but weren't fast enought o run a strip off. lately I have been giving off a lot of PVC's, when the heart flip flops and settles down that's when the pain increases.

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    • Posted

      Hi Samuels, thanks for your message - plenty of questions and some comments regarding the burning sensation... but I'm exhausted (from having walked for 5 minutes today! It must be the clopdigprel surely?! Which is interesting as that's the one thing you don't seem to be on...which must mean you haven't had an MI recently (at least in the 12 months I would have thought as that's how long the prescribe it for after an MI) BUT I'm just crawling into bed here in the UK so will write tomorrow, if that's alright. Wishing you a pain free day/night ahead until then...

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    • Posted

      Hi nima,

      I was on clopidegrel but taken off it and put on low dose aspirin daily. Yes you will feel like absolute crap after having an NSTEMI, usually  start to feel normal after about  6- 8 weeks, you will tire more easily, find it hard to talk, get breathless easier and as you mentioned feel exhausted. I had my suspecte MI when  I was around 30, troponin blood tests weren't around back then, they had to rely on the CKMB blood tests for heart attacks then, they believe the medication Fenofibrate caused the MI, I had my second heart attack at the age of 46 and another one at the age of 47, they classed them as NSTEMI's, they tell me that the STEMI is the one to watch out for, see you have 2 types, there's a STEMI and NSTEMI, I believe the STEMI is a full blown heart attack where as the NSTEMI is still a heart attack but only in a mild form, I know it certainly doesn't feel like it but that's how they class them, then you have the other one, the fatal one.....cardiac arrest where the heart actually stops, my partner lost her cousin here a couple of weeks ago to a cardiac arrest, he was only 47.

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