From the Guidelines
Nitroglycerin (nitro) should not be used to treat chest pain that is non-cardiac in origin, as it is not effective and may cause unnecessary side effects. Nitroglycerin works by dilating blood vessels, particularly coronary arteries, which increases blood flow to the heart muscle and reduces the heart's workload, a mechanism that is beneficial for angina (cardiac chest pain) but provides little to no relief for chest pain stemming from other causes such as musculoskeletal issues, gastrointestinal problems, pulmonary conditions, or anxiety. According to the 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction 1, medical therapy with nitrates, beta blockers, and calcium channel blockers for patients with noncardiac chest pain is not recommended (Level of Evidence: C). This guideline suggests that the use of nitrates for non-cardiac chest pain is a Class III recommendation, indicating that the treatment is not recommended and may even be harmful.
Some of the potential causes of non-cardiac chest pain include:
- Musculoskeletal issues
- Gastrointestinal problems
- Pulmonary conditions
- Anxiety For these conditions, other treatments are more appropriate, such as anti-inflammatory medications for musculoskeletal pain, acid reducers for gastrointestinal issues, or other targeted therapies depending on the diagnosis. If you're experiencing chest pain, it's crucial to seek medical evaluation to determine the cause rather than self-medicating with nitroglycerin, as a healthcare provider can diagnose the source of your chest pain and recommend appropriate treatment specific to the actual cause. Taking nitroglycerin for non-cardiac chest pain may cause side effects like headache, dizziness, and low blood pressure without addressing the underlying cause of the pain, highlighting the importance of seeking professional medical advice for accurate diagnosis and treatment.
From the Research
Non-Cardiac Chest Pain Treatment
- Non-cardiac chest pain (NCCP) is a common and challenging clinical problem that requires targeted diagnostic assessment to identify the underlying cause of the symptoms 2, 3.
- The treatment of NCCP is tailored according to the cause, which can include gastroesophageal reflux disease (GERD), esophageal dysmotility, or functional chest pain 2, 3.
Nitroglycerin Use for Chest Pain
- Nitroglycerin is commonly used as a first-line agent for angina and to manage chest pain due to acute coronary syndromes 4.
- However, the use of nitroglycerin for non-cardiac chest pain is not well established, and its effectiveness in relieving NCCP is unclear 5.
- A study found that relief of chest pain with nitroglycerin is not a reliable diagnostic test and does not distinguish between cardiac and non-cardiac chest pain 5.
Treatment Options for Non-Cardiac Chest Pain
- Treatment options for NCCP include proton pump inhibitors, antidepressants, theophylline, and cognitive behavioral therapy, which appear to be useful for relieving symptoms 6.
- Other treatment options, such as nitrates, have poor evidence to support their use in treating NCCP 6.
- Nitroglycerin, a nitrate, may not be effective in relieving non-cardiac chest pain, and its use should be approached with caution 5.