Educating patients in the proper use of nitroglycerin
Angina pectoris is a discomfort behind the breastbone caused by a temporary inadequacy of blood flow to the heart muscle. It is not a heart attack. There is no heart damage. Many patients have had thousands of such episodes and live full and active lives reaching a ripe old age.
Nitroglycerin is a true wonder drug. When it is taken properly, it can help patients with angina achieve the goal of a pain-free life with little or no limitations. Nitroglycerin both dilates the coronary arteries and decreases the workload of the heart. When you learn to take nitroglycerin properly, your heart is able to do much more work without developing angina. It is common to see patients with angina return to full activity largely because they have mastered the proper use of nitroglycerin.
Once the nitroglycerin prescription is filled, it is worthwhile to transfer a number of pills to a small pillbox that you can carry with you at all times. The rest of the tablets should be kept in the original glass bottle tightly closed. Even in the bottle, once it is unsealed, the pills may lose potency in three or four months and should be replaced. Even though nitroglycerin is the same chemical used in dynamite, the pills are not explosive. No matter how hard the pillbox is shaken or jostled, nothing will happen except that the pills may crumble.
When a nitroglycerin tablet is needed, it is placed under the tongue and allowed to dissolve. This takes about twenty to thirty seconds. Nitroglycerin can also be chewed with good effect. It should not, however, be swallowed. If you do accidentally swallow one, don't be concerned. It just does not work that way. When taking nitroglycerin it helps to sit up, if recumbent, leaning forward into the pain. Take a deep breath and bear down as if for a bowel movement and put the nitroglycerin tablet under your tongue. If you chest discomfort tends to wake you from sleep, keep nitroglycerin on your bedside table. Be sure to sit up while taking it.
Once a nitroglycerin tablet is placed in the mouth, it tingles slightly. It promptly exerts its effect by widening arteries and increasing the blood supply to many parts of the body. A good sign that the blood flow is increasing throughout the body, including the heart, is warmth, fullness or throbbing in the head. If you happen to be one who develops little or no sensation in the head, the tingle under the tongue will indicate that the pills are still fresh and active.
Nitroglycerin is most helpful when taken at the first onset of chest discomfort rather than after it has been present for several minutes. Onset of action of the nitroglycerin is prompt. Relief of discomfort is generally obtained within one or two minutes. Experience will rapidly teach you which types of chest discomfort respond to nitroglycerin. Many discomforts or pains in the chest area do not arise from the heart. Although on rare occasions nitroglycerin will relieve such discomfort, it generally proves ineffective for pains arising outside the heart. If you find that nitroglycerin consistently fails to relieve a certain pain, there is no need to continue taking the pill for that specific pain. Before you make such a decision, however, check with your doctor and give him all the details.
The vast majority of patients with angina find that chest discomfort, when it occurs, is relieved simply by slowing their pace a bit. This is a useful observation. Nevertheless, even though you know the discomfort probably will fade just with resting or slowing down, you should always take nitroglycerin at the first onset of angina. One cannot be certain in advance whether a minor discomfort will abate or increase in severity and injure the heart. Taken early, nitroglycerin prevents such problems and protects the heart from possible injury. When chest discomfort is promptly relieved by nitroglycerin it will usually be unnecessary to interrupt your activities. A moderate decrease in the pace of activities is advisable. Many people who have chest discomfort in the early morning of at the first tee on a golf course are able to complete a full day's work or eighteen holes of golf without further discomfort.
Better still than taking nitroglycerin when chest discomfort develops, is to take a pill in anticipation of such discomfort. One rapidly learns when angina is likely to occur; under such circumstances of increased exertion, excitement or emotion, it is worthwhile taking a nitroglycerin prophylactically and preventing the angina entirely.
Nitroglycerin is not habit forming. It is not a narcotic or painkiller. It is permissible to take nitroglycerin many times during the course of a day. No matter how often you use it, it will consistently continue to work for you. It will help the following circumstances. *Brisk walking outdoors on a cold, windy day Exertion after a heavy meal Working under the pressure of a deadline Speaking in public During sexual intercourse During worry, tension or anger
If you find that these or similar stresses will bring on an angina episode, take one or more nitroglycerin pills before such an event to prevent angina. This is the wisest way to take nitroglycerin. Many patients have taken five to ten nitroglycerin pills daily over many years and have not experienced any chest discomfort at all. They have really mastered the art of properly using nitroglycerin.
There are a few circumstances in which you may require further advice or assistance. If a nitroglycerin tablet does not relieve angina within two or three minutes, take a second tablet. In a few more minutes, if relief is only brief and discomfort returns, take a third pill. After three pills, if discomfort is not completely controlled, or if it returns within minutes, call your doctor at once. If you cannot immediately reach the physician, have someone drive you to the nearest hospital emergency ward.
Report immediately to your doctor if any of these changes occur in the pattern of chest pain: *More severe episodes *More frequent episodes *More prolonged episodes *Chest discomfort brought about by lesser exercise or lesser excitement *Nitroglycerin becomes less effective (be sure the tablets are fresh) *Chest discomfort that occurs only in the daytime now also develops at night *Chest discomfort that always comes with exertion begins to occur during rest as well
Finally, remember that many angina patients have lived full and active lives to old age. When nitroglycerin is properly and freely used, it will improve and prolong your life.
Citations: ©Copyright 1978 by Bernard Lown, MD and Stephen H. Rabinowitz, MD. All rights reserved. 1560 Beacon St., Brookline, MA 02146
Date Posted: 14 July 2008