Managing Angina with Glyceryl Trinitrate (GTN)

Understanding Angina

Chronic Condition and Artery Narrowing

• Common Age-Related Risk: Artery narrowing is a part of aging, with males more at risk until post-menopause, where risks become equal for both genders.
• Atherosclerotic Plaque Build-Up: Angina results from the accumulation of atherosclerotic plaques within blood vessels.
• Significance of Tube Diameter: Reducing the diameter of an artery significantly limits blood, oxygen, and nutrient flow due to the exponential relationship between diameter and fluid flow.
• Stress and Reduced Blood Flow: During stress or exercise, the heart's increased workload can surpass the limited oxygen supply due to plaque-induced occlusion, leading to lactic acid build-up and pain.

Managing Angina and Associated Chest Pain

Effective Strategies for Angina Relief

• Reducing Heart Workload: Reassure and relax patients to minimize stress and discomfort.
• Diagnostic Assessment: Perform an ECG for evaluation.
• Supplemental Oxygen: Administer oxygen if oxygen saturation falls below 95%.
• GTN Administration: Consider GTN spray or sublingual tablet if systolic blood pressure is over 100 mmHg.

Glyceryl Trinitrate (GTN) Use

Relieving Angina with GTN

GTN Spray: Pre-hospital use with 400 micrograms per spray.

• Administration: Instruct the patient to lift their tongue, administer one spray under the tongue, and close the mouth immediately.
• Side Effects: Warn patients about potential side effects, including throbbing headaches.
• Mechanism: GTN relaxes arterial muscle, reducing blood return to the heart and subsequently lowering heart workload and oxygen requirements, alleviating angina pain.
• Alert for Acute Coronary Syndrome: Monitor for angina at rest, as it may indicate a transition to acute coronary syndrome and a heightened risk of a heart attack or myocardial infarction.