From the Guidelines
You should seek immediate medical attention for your recurring chest pain requiring frequent nitroglycerin use, as this pattern could indicate unstable angina or worsening heart disease. Using nitroglycerin every other day suggests your underlying condition is not adequately controlled and represents a dangerous situation that requires prompt evaluation. According to the guidelines outlined in 1, if chest discomfort/pain is unimproved or worsening, it is recommended to call 9-1-1 immediately to access EMS.
Key Considerations
- Frequent chest pain requiring regular nitroglycerin use often indicates inadequate oxygen supply to your heart muscle, which could lead to a heart attack if not properly addressed.
- A proper evaluation may include an EKG, blood tests, and possibly cardiac catheterization to determine if you have significant coronary artery blockages.
- Your doctor might adjust your medications, potentially adding daily preventive medications like beta-blockers, calcium channel blockers, or long-acting nitrates, as suggested in 1.
- They may also recommend lifestyle changes such as diet modification, exercise as tolerated, stress reduction, and smoking cessation if applicable.
Next Steps
- Call 911 or have someone take you to the emergency room right away.
- Inform your healthcare provider about your frequent nitroglycerin use and chest pain episodes.
- Be prepared to discuss your symptoms, medical history, and any concerns you may have with your healthcare provider, as emphasized in 1.
From the FDA Drug Label
If the pain persists after a total of 3 tablets in a 15-minute, period, or is different than you typically experience, call your doctor or seek emergency help.
You should call your doctor or seek emergency help because your chest pain is recurring and you've been taking nitroglycerin every other day, which may indicate that your treatment plan needs to be adjusted. 2
From the Research
Recurring Chest Pain and Nitroglycerin Use
- You have been experiencing recurring chest pain and have been taking nitroglycerin (NTG) every other day to relieve the symptoms.
- According to a study published in 2020 3, chest pain can be caused by various factors, including coronary artery vasospasm, which can be relieved with nitroglycerin.
- However, another study published in 2006 4 found that relief of chest pain with nitroglycerin is not a reliable diagnostic test to distinguish between cardiac and non-cardiac chest pain.
Diagnostic Considerations
- A study published in 2010 5 highlights the importance of accurate diagnosis and treatment of chest pain, whether it is of cardiac or non-cardiac origin.
- The study suggests that further testing, such as exercise testing and angiography, may be necessary to determine the cause of chest pain.
- Another study published in 2003 6 found that chest pain relief with nitroglycerin does not predict active coronary artery disease.
Evaluation and Management
- A study published in 2001 7 outlines a systematic approach to evaluating chest pain, including determining whether the pain is cardiac in origin and assessing the likelihood of significant coronary artery disease.
- The study emphasizes the importance of considering the patient's history, risk factors, and electrocardiogram results in determining the likelihood of coronary artery disease.
- According to the study published in 2020 3, calcium channel blockers can be effective in managing symptoms of coronary artery vasospasm, and avoidance of triggers can also help in symptom management.
- Additionally, the study published in 2006 4 suggests that the diagnostic sensitivity of nitroglycerin to determine cardiac chest pain was 72% (64%-80%), and the specificity was 37% (34%-41%).