Glyceryl trinitrite (GTN)
Glyceryl trinitrate (GTN) has been in continuous medical use for over 100 years and is still an important treatment to rapidly relieve symptoms of angina. Patients who have mastered the proper use of this agent regard it as a “wonder drug.”
Angina is discomfort in the chest located behind the breastbone provoked by a temporary lack of blood flow to heart muscle. Angina does not indicate a “heart attack," and it does not damage the heart muscle. Angina is not caused by sudden closure of the coronary artery but it results from a transient mismatch between restricted blood flow in a narrowed coronary artery and an increased bodily demand for the heart to pump more blood. GTN dilates coronary vessels and decreases the heart’s workload. The mechanism is due to release of a powerful vasodilator called nitric oxide.
If taken correctly GTN helps patients with angina achieve a pain-free and unrestricted lifestyle. Simple instructions are required and when a tablet is needed, it is placed under the tongue and allowed to dissolve. This takes about 30 seconds. The GTN can be chewed but is less effective if swallowed. Its effects can be hastened by sitting, leaning forward or inhaling deeply. GTN causes a tingling sensation under the tongue. Its dilating action is not limited to the arteries supplying blood to the heart. It also causes a facial flush, lightheadedness, or throbbing fullness or sensation of warmth in the head. Some patients complain of headache of varying severity. When the patient is assured that the mild untoward reactions are but part of the drug’s repertoire, symptoms are generally minimized. GTN maintains its potency when secured in a tightly closed bottle for 3 to 4 months.
GTN is more effective when taken at the start of chest discomfort. It is even better to take a pill in anticipation of angina. Most patients having angina are aware of the factors that produce discomfort. The circumstances are generally exertion, excitement, or deep emotion. Angina is most likely under the following conditions: When walking briskly outdoors on a cold, windy, or humid day; when hurrying with a heavy briefcase or bundles; when exerting after a heavy meal; when working under the pressure of a deadline; when speaking in public; when engaging in sexual activity; and when worried, tense, and especially when angry. GTB taken to prevent attacks is advisable.
After taking a GTN under the tongue relief follows usually in 1-2 minutes. Not all types of chest pain will respond to GTN. This proves helpful in differentiating symptoms caused by impaired blood flow in the coronary vessels or a diversity of non-cardiac conditions. GTN may interact with other cardiac medication, and this should be discussed with your doctor.
It is common for the doctor to give the patient a prescription, with the sole instruction to put the pill under the tongue during chest discomfort. The doctor often alerts the patient that the use of GTN may be associated with lightheadedness or a throbbing headache. Patients so instructed infrequently resort to GTN. They generally reserve it for a more severe episode of angina that does not immediately abate when they stop whatever they are doing. Patients commonly think that the less they resort to GTN, the less serious their disease. Some fear addiction, habituation, or loss of efficacy at a time when they might really need it. Some are impeded in its use because of unease in exposing the fact that they suffer from a heart condition for fear of losing a job or arousing undue anxiety in a spouse. A common rationalization is that because the discomfort is transient, far preferable to taking a pill is to stop the exertion that provoked the angina in the first place. It is therefore important for the patient to understand that GTN is not habit-forming and is neither a narcotic nor a painkiller. It is permissible to take GTN numerous times during the course of the day without adverse consequences.
I encourage patients with newly diagnosed angina to take a sublingual GTN in our presence when they are not experiencing angina. While the drug is acting, explanation of its pharmacology and beneficent action proves valuable. These patients almost never have side effects and more readily resort to its use. Viagra, used to treat erectile dysfunction, is not indicated for patients taking oral nitrates, nitroglycerin patches, or sublingual preparations. If one is experiencing angina that is not substantially relieved by GTN, or if the discomfort recurs after a single GTN pill, seeking the closest medical facility is an appropriate response.
Fear and anxiety is common among heart disease patients. This is not at all surprising, as many are aware that sudden cardiac death or a disabling heart attack are possible outcomes of their condition. The occurrence of angina is therefore a disquieting reminder of one’s uncertain hold on life. A wealth of data shows that psychological stress is an adverse prognostic factor for patients with coronary artery disease. Stress is invariably diminished by purposeful activity. Being able to terminate an anginal episode promptly, or better still to prevent its occurrence, puts one in control. Taking GTN is a self-empowering act and being in control ameliorates fear and anxiety.
When GTN is properly and frequently used, it will improve the patient’s quality of life. Patients experiencing angina can avoid costly interventions by being treated medically. Neither life’s duration nor the patient’s well-being is thereby compromised. Taking nitroglycerin freely, without anxiety, fosters self reliance—a highly desirable goal for all patients.
If you want to find out more about the history of GTN then a lecture I delivered can be found here: An Explosive Treatment for Angina - The History of GTN use in Heart Disease
Angina is discomfort in the chest located behind the breastbone provoked by a temporary lack of blood flow to heart muscle. Angina does not indicate a “heart attack," and it does not damage the heart muscle. Angina is not caused by sudden closure of the coronary artery but it results from a transient mismatch between restricted blood flow in a narrowed coronary artery and an increased bodily demand for the heart to pump more blood. GTN dilates coronary vessels and decreases the heart’s workload. The mechanism is due to release of a powerful vasodilator called nitric oxide.
If taken correctly GTN helps patients with angina achieve a pain-free and unrestricted lifestyle. Simple instructions are required and when a tablet is needed, it is placed under the tongue and allowed to dissolve. This takes about 30 seconds. The GTN can be chewed but is less effective if swallowed. Its effects can be hastened by sitting, leaning forward or inhaling deeply. GTN causes a tingling sensation under the tongue. Its dilating action is not limited to the arteries supplying blood to the heart. It also causes a facial flush, lightheadedness, or throbbing fullness or sensation of warmth in the head. Some patients complain of headache of varying severity. When the patient is assured that the mild untoward reactions are but part of the drug’s repertoire, symptoms are generally minimized. GTN maintains its potency when secured in a tightly closed bottle for 3 to 4 months.
GTN is more effective when taken at the start of chest discomfort. It is even better to take a pill in anticipation of angina. Most patients having angina are aware of the factors that produce discomfort. The circumstances are generally exertion, excitement, or deep emotion. Angina is most likely under the following conditions: When walking briskly outdoors on a cold, windy, or humid day; when hurrying with a heavy briefcase or bundles; when exerting after a heavy meal; when working under the pressure of a deadline; when speaking in public; when engaging in sexual activity; and when worried, tense, and especially when angry. GTB taken to prevent attacks is advisable.
After taking a GTN under the tongue relief follows usually in 1-2 minutes. Not all types of chest pain will respond to GTN. This proves helpful in differentiating symptoms caused by impaired blood flow in the coronary vessels or a diversity of non-cardiac conditions. GTN may interact with other cardiac medication, and this should be discussed with your doctor.
It is common for the doctor to give the patient a prescription, with the sole instruction to put the pill under the tongue during chest discomfort. The doctor often alerts the patient that the use of GTN may be associated with lightheadedness or a throbbing headache. Patients so instructed infrequently resort to GTN. They generally reserve it for a more severe episode of angina that does not immediately abate when they stop whatever they are doing. Patients commonly think that the less they resort to GTN, the less serious their disease. Some fear addiction, habituation, or loss of efficacy at a time when they might really need it. Some are impeded in its use because of unease in exposing the fact that they suffer from a heart condition for fear of losing a job or arousing undue anxiety in a spouse. A common rationalization is that because the discomfort is transient, far preferable to taking a pill is to stop the exertion that provoked the angina in the first place. It is therefore important for the patient to understand that GTN is not habit-forming and is neither a narcotic nor a painkiller. It is permissible to take GTN numerous times during the course of the day without adverse consequences.
I encourage patients with newly diagnosed angina to take a sublingual GTN in our presence when they are not experiencing angina. While the drug is acting, explanation of its pharmacology and beneficent action proves valuable. These patients almost never have side effects and more readily resort to its use. Viagra, used to treat erectile dysfunction, is not indicated for patients taking oral nitrates, nitroglycerin patches, or sublingual preparations. If one is experiencing angina that is not substantially relieved by GTN, or if the discomfort recurs after a single GTN pill, seeking the closest medical facility is an appropriate response.
Fear and anxiety is common among heart disease patients. This is not at all surprising, as many are aware that sudden cardiac death or a disabling heart attack are possible outcomes of their condition. The occurrence of angina is therefore a disquieting reminder of one’s uncertain hold on life. A wealth of data shows that psychological stress is an adverse prognostic factor for patients with coronary artery disease. Stress is invariably diminished by purposeful activity. Being able to terminate an anginal episode promptly, or better still to prevent its occurrence, puts one in control. Taking GTN is a self-empowering act and being in control ameliorates fear and anxiety.
When GTN is properly and frequently used, it will improve the patient’s quality of life. Patients experiencing angina can avoid costly interventions by being treated medically. Neither life’s duration nor the patient’s well-being is thereby compromised. Taking nitroglycerin freely, without anxiety, fosters self reliance—a highly desirable goal for all patients.
If you want to find out more about the history of GTN then a lecture I delivered can be found here: An Explosive Treatment for Angina - The History of GTN use in Heart Disease