Many people think of “angina pectoris” or “myocardial infarction” when they think of chest pain, and once they have an attack of chest pain at home, they will take nitroglycerin (with or by spraying) as soon as possible. Is this the right approach?
First of all, not all chest pains are angina pectoris
It may be a respiratory, thoracic or even dermatological disease: pneumonia, pulmonary embolism, intercostal neuralgia, aortic coarctation, pneumothorax, shingles …… If it is one of these diseases, nitroglycerin will definitely not work and may produce side effects when taken.
Secondly, which kind of chest pain is more like angina pectoris
Patients themselves are more difficult to judge, the following performance can be used as a reference, of course, not absolute, but also need a doctor for professional judgment.
More like angina pectoris (or myocardial infarction).
A history of coronary heart disease, or high-risk factors (hypertension, diabetes, hyperlipidemia, smoking, etc.).
Chest tightness and shortness of breath.
A sore or tight throat.
Pain that is “all over the place”.
Pain that spreads to the back of the shoulder.
Pain that lasts for several minutes or longer.
Worse with activity, less with rest.
It is less like angina pectoris.
A definite trauma.
Pins-and-needles pain.
Pain that is “spotty” in extent and can be pinpointed with the finger.
Pain relieved in a few seconds.
Breathing-related, e.g., it hurts especially when inhaling deeply.
Position-related, e.g., pain is only apparent in one position, but improves with a change of position.
Activity can reduce the symptoms.
Third, not all angina pectoris (myocardial infarction) can take nitroglycerin
The human heart is divided into the left heart and the right heart, the supply of the left heart and the right heart are different coronary arteries, the lesion mechanism is different. Nitroglycerin mainly dilates veins and has its own hypotensive effect. For coronary artery lesions involving the left heart, nitroglycerin can be used; for coronary artery lesions involving the right heart, nitroglycerin should not be used because it may cause severe hypotension and aggravate the condition.
So how to determine it at home? The easiest way: take your blood pressure! If the blood pressure is already below 90/60mmHg before taking the drug, or if it is above this value but significantly lower than usual, do not use nitroglycerin.
Fourth, how to take nitroglycerin
Find a peaceful environment, such as sitting on a bed, never standing.
If it is a tablet, take it under the tongue, do not swallow it; if it is a spray, spray it under the tongue.
If you take one tablet for 3-5 minutes and it doesn’t work, take another one. If it doesn’t work three times, don’t use it anymore and seek medical attention quickly.
Fifth, what conditions need to go to the hospital
Except for the diagnosis of stable angina, and each attack nature, degree, triggering conditions, the frequency of attacks are relatively fixed, you can self-administer nitroglycerin. In all other cases, the sooner the better, do not “wait for the rain to stop”, “wait for the dawn”, “wait for the children to leave work”. The emergency department is open 24 hours a day, but many patients miss the best time for treatment while waiting, which is saddening.