Introduction
If you suffer from angina, you may have been prescribed a Glyceryl Trinitrate (GTN) spray. However, you may be unsure of the correct way to use the spray, how often you can use it, and if there are any precautions or side effects to consider.
This article will go through what angina pectoris is and its symptoms, how to use the nitro lingual pump spray when you get an angina attack, and other ways of managing angina attacks. The aim of the article is to take you through the proper way and how often to use a GTN spray.
The three important takeaway points:
- Angina is also known as angina pectoris and it is a symptom of coronary artery disease (CAD)
- Always have your nitroglycerin spray or tablets with you at all times and in all places.
- The use of GTN spray is mainly for quick relief of angina attacks or to prevent angina attacks before an activity.
Angina
What is Angina?
Angina is also known as angina pectoris or ischemic chest pain, which is a symptom of heart disease or coronary artery disease (CAD).
It occurs when there is reduced blood flow to the heart muscles, either from the narrowing or the hardening of the arteries.
Most people describe the feeling of angina as pressure on the chest, a feeling of heaviness, and tightness or pain in the chest.
Symptoms of Angina
The following are the symptoms of angina pectoris:
- Chest pain
- Chest discomfort (may come as squeezing, heaviness, or tightness in the chest)
- Pain may radiate to the arks, neck, jaw, shoulders, and other parts of the body
- Dizziness
- Fatigue
- Nausea or stomach upset
- Shortness of breath
- Sweating
Causes of Angina
Angina pectoris is caused by reduced blood flow to the heart muscles. Usually, the blood carries oxygen around the body. When enough blood is not able to reach the heart muscles, the heart is starved of oxygen, and this condition is known as ischemia.
The most common cause of angina is coronary artery disease (CAD). In this condition, the heart arteries are narrowed by the accumulation of fat deposits (plaques), a condition known as atherosclerosis. It makes the path of blood flow narrower, allowing less blood to reach the heart muscle, which in turn causes a low oxygen supply.
During less strenuous activities or at rest, less oxygen is required and this does not cause chest pain. But, during strenuous activities, more oxygen is demanded by the heart which may lead to angina.
Types of Angina
Angina is classified into three parts below:
Stable angina:
The most common form of angina. As the name implies, it is predictable compared to other angina types; it occurs during vigorous activity and subsides when you take a rest and can be controlled by medications.
Unstable angina:
By Its name, it's quite unpredictable and can even occur at rest and may not subside even with medication. It is a precursor to heart attack and it's the intermediate stage between stable angina and myocardial infarction (heart attack).
Variant or Vasospastic or Prinzmetal angina:
It is caused due to the vascular spasm of the heart muscle. It may occur at rest or even while asleep. It is a rare yet severe form of angina.
Angina Spray: Glyceryl Nitrate
Glyceryl nitrate is also known as Nitroglycerin, Nitrolingual Pumpspray, GTN spray, or angina spray. It is a vasodilator and also under the class of nitrates.
How it works
It works by dilating the narrowed blood vessels, which allows more blood to be carried to the heart, thereby increasing the oxygen supply to the coronary muscles.
It also works by relaxing the vascular smooth muscle, which results in a reduction of venous return and improved myocardial perfusion (flow of blood through the heart muscles) with a resultant reduction in the work performed by the heart and hence reduced oxygen demand.
When to use GTN
GTN spray is a quick-acting medicine for angina that is sprayed on the tongue or under the tongue when you experience an angina attack or before a strenuous activity that can lead to angina symptoms. Therefore, it is used to treat or prevent angina attacks before an activity that requires more oxygen, such as exercising or climbing the stairs.
Once you experience the first symptoms of chest pain, administer 1-2 sprays under your tongue and wait for 5 minutes before administering the second or third dose.
If you're still experiencing chest pain after the third dose, contact emergency services, as the chest pain may be a sign of a heart attack.
You should not use the Nitrolingual pump spray more than 3 times within a 15-minutes period for an angina attack.
How to use GTN
Before using your Nitrolingual pump spray, you need to check the functionality by pressing the button on the nozzle at the top of the bottle a few times till a fine mist comes out.
- Firstly, have a seat
- If you haven't been using your GTN spray for a while, spray once into the air
- Place the nozzle of the bottle in front of your mouth, press the button and take a deep breath
- Open your mouth and lift your tongue
- Then, press the button firmly and spray under your tongue
- Do not breathe in while spraying and close your mouth when done spraying
- Breath through your nose
- Keep your mouth close for a while and rest a bit before standing up
Make sure you always have a spare spray with you.
Precautions before use
If you have been prescribed a GTN spray, let your doctor know if you have or have had any of these conditions before using it:
- Hypersensitivity or allergy to glyceryl nitrate or any other ingredients present
- Severe low blood pressure- postural hypotension
- Hypothyroidism
- Brain trauma or cerebral haemorrhage
- Liver or kidney problems
- History of myocardial infarction
- Severe anaemia
- Heart attack
- Congestive heart failure
- Hypovolemia- low volume of blood
- Severe Anaemia
Side effects of GTN
The following are the side effects of Glyceryl nitrate spray:
- Drowsiness
- Reduced blood pressure
- Blurred vision
- Headache
- Dizziness
- Nausea
- Red face (flushing)
- Vertigo
- Burning sensation
Other Ways to Manage Angina
There are other options for treating angina apart from the use of glycerol nitrate.
One of the best options is making changes to your lifestyle. Maintaining a healthy weight, exercising as much as is safe, and avoiding unhealthy habits such as drinking alcohol and smoking are the best ways to combat heart disease and contribute to better overall heart health.
There are also other medications apart from nitrates, which include:
- Aspirin
- Antiplatelets
- Beta-blockers
- Statins
- Angiotensin-converting enzyme inhibitors (ACEIs)
- Calcium channel blockers
- Ranolazine
Beta-blockers
Beta adrenoceptor antagonists or blockers work by blocking the adrenergic receptors in the heart and thereby decreasing the heart rate, blood pressure, and heart muscle contractility and oxygen demand during exercise. Beta-blockers are the first line of therapy with stable angina, as they relieve angina symptoms, reduce the frequency of angina attacks, and reduce angina severity. examples include Atenolol and Metoprolol.
ACE Inhibitors
These work by widening the blood vessels, thereby increasing the amount of blood the heart pumps and lowering the blood pressure. It works by inhibiting an enzyme, making the blood vessels relax and widen. It has a long-term benefit by reducing the damage to blood vessels by angina and reducing the risk of heart attack. Types of ACE inhibitors include Lisinopril, Captopril, and Enalapril.
Calcium Channel Blockers
They act by relaxing the muscles that line the blood vessels. This leads to the widening of the narrowed blood vessels and reduces the frequency of angina attacks. Examples are Amlodipine, and Nifedipine.
Summary
In summary, angina is a symptom of coronary heart disease (CAD) that causes chest pain and should not be confused with other health conditions that cause chest pain such as heartburn.
You should talk to a doctor early if you feel chest pain, especially when you engage in strenuous activities, so that it can be properly diagnosed. Make sure to use your GTN spray as prescribed by your physician and practice lifestyle modifications like avoiding smoking and alcohol, engaging in physical activities, and eating healthy food.
References
- “Glyceryl Trinitrate (GTN): Used to Treat Angina (Chest Pain) and Anal Fissures.” Nhs.Uk, 18 Mar. 2020, https://www.nhs.uk/medicines/glyceryl-trinitrate-gtn/.
- “Angina - Symptoms and Causes.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/angina/symptoms-causes/syc-20369373. Accessed 3 Mar. 2022.
- Watson, Stephanie. “Angina (Ischemic Chest Pain).” WebMD, https://www.webmd.com/heart-disease/heart-disease-angina. Accessed 3 Mar. 2022.
- Zealand (www.bka.co.nz), Site designed and developed by bka interactive ltd, Auckland, New. “Glyceryl Trinitrate (Spray) | Health Navigator NZ.” Health Navigator New Zealand, https://www.healthnavigator.org.nz/medicines/g/glyceryl-trinitrate-spray/. Accessed 3 Mar. 2022.
- Glyceryl Trinitrate Spray 400 Micrograms/Metered Dose, Sublingual Spray - Summary of Product Characteristics (SmPC) - (Emc). https://www.medicines.org.uk/emc/product/674/smpc#gref. Accessed 3 Mar. 2022.
- Nitroglycerin (Oral Route, Sublingual Route) Precautions - Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/nitroglycerin-oral-route-sublingual-route/precautions/drg-20072863?p=1. Accessed 3 Mar. 2022.
- “GTN Spray: View Uses, Side Effects, Price and Substitutes.” 1mg, https://www.1mg.com/drugs/gtn-spray-172266. Accessed 3 Mar. 2022.
- What Are the Different Types of Angina?: Premier Cardiology Consultants: Cardiologists. https://www.premiercardiology.com/blog/what-are-the-different-types-of-angina. Accessed 3 Mar. 2022.
- Angina - Diagnosis and Treatment - Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/angina/diagnosis-treatment/drc-20369378. Accessed 3 Mar. 2022.
- Marcos Mello. “Treatment of Angina.” News-Medical.Net, 29 Aug. 2012, https://www.news-medical.net/health/Treatment-of-angina.aspx.
In your instructions for taking the spray you seem to be saying, put the spray in front of your mouth, press the button, take a deep breath. Then you say press the button firmly and direct into mouth. A bit confusing that seeing as you say do not breath in whilst spraying.