🎓 Heart Health Medication Series: Know Your Meds, Know Your Heart

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Lesson 8: The Immediate Lifeline – GTN Spray (Glyceryl Trinitrate)

⚠️ A Note of Caution

This content is for educational purposes only and is NOT medical advice. If you have been diagnosed with a heart condition, you must always consult your Heart Failure Specialist Nurse, Cardiologist, and medical team for guidance specific to your treatment and care plan.

For a patient with LVSD (EF 20%) who also experiences angina (chest pain from reduced blood flow), the GTN (Glyceryl Trinitrate) Spray is the most crucial, fast-acting medication for immediate symptom relief. It's an emergency tool and must be used correctly.

What is GTN Spray?

GTN is a type of Nitrate and a powerful, fast-acting Vasodilator. It is usually administered as a fine mist sprayed under the tongue (sublingually).

The Science: Opening the Pipes

When chest pain occurs, it means the heart muscle is not receiving enough oxygen (a condition called Ischemia). GTN works in seconds to alleviate this by:

  1. Relaxing Veins (Primary Action): It relaxes the large veins, which reduces the amount of blood flowing back to the heart. This means the heart has less blood to pump out, dramatically reducing the workload and oxygen demand of the struggling left ventricle.

  2. Dilating Coronary Arteries (Secondary Action): It relaxes the small arteries leading to the heart muscle, potentially increasing the oxygen-rich blood supply.

The combined effect is rapid relief of chest pain, often within 1–3 minutes.

Crucial Procedure for Angina Relief

Using GTN correctly is vital, as it dictates when you need to call for emergency help. Your specialist nurse will have provided specific instructions, but the general protocol is:

  1. Stop Activity: Sit down immediately, or rest. Do not stand, as the drop in blood pressure could cause you to faint.

  2. Dose 1: Spray one dose under your tongue. Wait five minutes.

  3. Dose 2 & Emergency Call: If the pain is not completely gone, spray a second dose under your tongue and CALL 999 (UK Emergency) immediately.

  4. Dose 3 (If needed): If the ambulance has not arrived after a further five minutes, you may take a third dose. Do not exceed three doses.

Key Things to Watch Out For

  1. Headache: A severe throbbing headache is the most common side effect. This is actually a sign the GTN is working, as it dilates blood vessels in the head. While uncomfortable, it is temporary.

  2. Low Blood Pressure (Fainting): Because GTN is a powerful vasodilator, the rapid drop in blood pressure can cause dizziness or fainting. Always sit down before use.

  3. Storage: GTN spray must be stored at room temperature and kept in its original container to protect it from light and moisture. Do not refrigerate.

  4. Expiry: The GTN spray can lose potency after the expiry date or if it has been opened for too long (check the bottle/leaflet). Ensure you always have a fresh, unexpired canister.

Key Advice: Carry your GTN spray with you at all times. If you have to take a second dose and call 999, make sure to let the paramedics know exactly how many sprays you took and when.

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