What pains are relieved by nitroglycerin. Nitroglycerin: properties, indications and contraindications, how to apply in various forms and cases

The drug for the second century quickly and effectively makes life easier for patients with heart disease. But the study and creation of various pharmacological forms continues. For a long time, scientists and physicians have discovered many beneficial properties and found out what nitroglycerin helps from, affecting the vascular system.

How Nitroglycerin Works

The mechanism of action of nitroglycerin is no longer a mystery since the end of the twentieth century. Scientists who discovered it were awarded Nobel Prize. The drug has a relaxing effect on the smooth muscle layer vascular wall, due to which the lumen of the vessel becomes wider.

The reason for this is the nitrogen released from nitroglycerin. It reacts with free oxygen and forms nitric oxide, which activates a special substance - guanylate cyclase, which is responsible in the body for relaxing smooth muscles.

Nitroglycerin - what helps the drug

Smooth muscle fibers are located not only in the vessels. They are also contained in the walls of the intestines, bronchi, ureters, bile and pancreatic ducts. Using nitroglycerin, you can relieve the spasm of these anatomical formations.

• The cardiovascular system. The main and most commonly used "target" of nitroglycerin.
  • By dilating the coronary arteries, the drug increases the flow of oxygen-rich blood to the heart muscle. As a result, angina pectoris pains are stopped.
  • Expansion of venous vessels, especially with intravenous administration drugs, reduces venous return to the heart, "unloading" its right sections. The result is a decrease in congestion, prevention of pulmonary edema. In addition, with a decrease in the load of blood volume on the heart, its oxygen demand decreases accordingly, which also has an analgesic effect in angina pectoris.
  • The drug is used in surgical interventions for controlled hypotension.
  • The rehabilitation period after a heart attack is also not complete without this drug.
  • Hypertension, accompanied by crises with pain in the heart and shortness of breath, is also an indication for the use of nitroglycerin.
• Bile and pancreatic ducts. Nitroglycerin relieves spasm of the walls of the ducts in biliary colic, gallbladder dyskinesia or acute pancreatitis.
• Gastrointestinal tract. The drug relieves pain with colic and dyskinesia.
• Urinary ducts. Relaxing the walls of the ureter, nitroglycerin relieves pain in renal colic.

Side effect

The wonderful property of the drug to relax smooth muscles can cause unpleasant consequences. The reason is the rapid expansion of blood vessels, a drop in blood pressure

• Headache, possible fainting.
• Cardiopalmus.
• Nausea, dyspepsia, feeling of dry mouth.

Overdose can cause nervous excitement, disorientation or lethargy. In severe intoxication, collapse, respiratory failure is observed, which requires immediate medical attention.

In case of fainting caused by taking nitroglycerin, the intake of the drug into the body should be stopped, the patient should be placed with raised legs and a slightly lowered head. Normalization of blood pressure usually occurs within 20 minutes.

Admission rules

For more than a hundred years, the pharmaceutical industry has produced a wide variety of forms of the drug. The most popular and effective are sublingual and buccal. Intravenous and dermal, as well as prolognated forms are also produced.

How to take nitroglycerin tablets under the tongue

Sublingual tablets of 0.5 mg. They should be taken to relieve angina pain. Rapid drug.

Acceptance rules. With an attack of pain like angina pectoris, you should stop the load during which it arose, sit down and put 1 tablet of nitroglycerin under the tongue. The patient will feel the effect in 1-3 minutes. Duration - up to 10 minutes. If it doesn’t help, you can take the second pill 5 minutes after the first one, and the third one 5 minutes later. Lack of pain relief within 15 minutes when using 3 tablets - a reason to apply for medical care, as the development of myocardial infarction is possible.

The conditions for storing tablets should be observed:

• in an open package (glass tube) nitroglycerin remains active for no more than two months;
• plastic packaging for nitroglycerin is not suitable; after three days of storage, it loses 80% of its effectiveness;
• the glass tube must be closed with a rubber stopper, without cotton wool, which absorbs nitroglycerin;
• An unopened package loses 32% of activity within a week.

From side effects most often there are headaches, a feeling of fullness, tinnitus, redness of the face. Perhaps dizziness, hypotension. This is due to the expansion of the venous vessels in the head and the difficulty of venous outflow.

To reduce side effects, you can take half a tablet of nitroglycerin, adding validol or menthol, which help improve venous outflow from the cranial cavity.

Other forms of nitroglycerin that have a quick effect

Not only tablets can be taken under the tongue. They also produce an alcoholic solution of nitroglycerin, oil solution in gelatin capsules, spray and aerosol, gum-bonded plates

• Alcohol solution. 4 drops of the solution are dripped onto a sugar cube (2-3 are enough for some patients), put under the tongue. As with sublingual tablets, three doses within 15 minutes are allowed in the absence of the desired effect.
• Gelatin capsules with oil solution. The application involves the placement of a capsule previously crushed by the teeth under the tongue.
• inhalation forms. Spray and aerosol with 1 spray emit 0.4 and 0.2 mg of nitroglycerin. One sublingual tablet corresponds to 2-4 valve presses. The spray effect comes on faster and lasts up to 20 minutes. The drug has proven itself in pulmonary edema and cardiac asthma. The drug is sprayed into the oral cavity, holding the breath. When inhaled aerosol may develop bronchospasm.

• Plates on the gum. Contain 4, 2 or 1 mg of nitroglycerin. Polymer plates are glued to the gums of the upper jaw in the area of ​​the canines and small molars. The effect occurs within 1 or 2 minutes, and lasts the entire period of resorption of the plate. It is individual and depending on this, the dose of the drug is selected. If resorption occurs within an hour and a half, a plate containing the drug is prescribed 1 mg, 2-3 hours - twice as much, 4-6 hours - 4 mg. If the load that causes pain has stopped earlier, it makes sense to remove the plate. If you want to increase the flow of nitroglycerin, you need to lick the plate two or three times.

Contraindications to taking nitroglycerin

Taking nitroglycerin may worsen the condition of patients with

• increased intracranial pressure;
• hemorrhage in the brain;
• allergies to nitrates;
• hypotension below 100/60 mm Hg. Art.;
• hypovolemia CVP less than 4-5 mm Hg. Art.;
• angle-closure glaucoma with high intraocular pressure;
• pregnancy, lactation;
• hypertrophic cardiomyopathy;
• severe renal and hepatic insufficiency;
• thyrotoxicosis.

The use of nitroglycerin, as well as other drugs, should be agreed with the attending physician after a thorough examination and an accurate diagnosis.

Explosive against toad

No matter what we are told from the TV screen, true revolutions in pharmacology are really rare. An example of this is the well-known drug nitroglycerin. Over the hundred-odd years that mankind has been in charge of it, scientists have not invented any other means for effective treatment angina. The packaging of the drug changes, the forms of its release change, and the active substance remains the same, surprisingly.

We owe the appearance of this medicine to the production of explosives: nitroglycerin was actively used (and is being used) for the preparation of smokeless powder. Back in the second half of the 19th century, the English doctor Murell thought that nitroglycerin vapors had a noticeable effect on workers involved in the production of explosives. He repeatedly checked his guess - and in 1879 a new medicine was introduced into medical practice.

Emergency care in different packages

TODAY, nitroglycerin is the only remedy that can quickly and reliably relieve a person from retrosternal pain, which is called angina pectoris, or angina pectoris. The drug belongs to a large group of nitrates. (Of course, this is not the same family that is used to fertilize potatoes.)

Nitrates are very popular all over the world. Each pharmaceutical company considers it its duty to increase their output, so today a very extensive range is deployed on the market - over fifty names. Despite the fact that nitroglycerin itself costs a penny, the pharmacy price of its drugs varies from double to triple digits. The most "advanced" option is a nitroglycerin patch: the drug can be absorbed both through the mucous membrane and through skin covering. Another trendy (and very expensive) option is aerosol cans.

The traditional form is a domestic tablet. Placed under the tongue, it begins its activity almost instantly. Taking a pill in the mouth, the patient thereby makes himself an injection. Analyzes show that the active substance appears in the blood by the end of the first minute. True, the therapeutic effect ends rather quickly - literally in a quarter of an hour.

In parallel with the action of nitroglycerin, a headache usually begins. This is its main drawback and at the same time an indicator. Two people out of ten will have a headache. As a rule, this happens in people who cannot physically tolerate this drug. Often this is due to problems with the vessels of the brain. Two more people will not have at all discomfort. The other six will make do with the pain moderate. Interestingly, this side effect can last longer action medicines.

There is a pattern: the headache is more pronounced in cases where the drug is taken for the first time. Over time, this side effect fades, but this is not a reason to rejoice. Very often, such an outcome signals that the medicine itself has become worse. For nitroglycerin, the problem of addiction is very relevant. In the 19th century fought with it, prescribing higher doses.

Nowadays, science creates long-acting nitrates. The drug is "hidden" in a special capsule, so that the drug can circulate in the blood for a long time.

Having attacked the saving path, manufacturing companies staged a real competition for the release of extended nitroglycerin: for two hours, for five, for ten. Several laboratories have created "supernitroglycerin" - one tablet lasts a whole day!

In terms of quality of life, it is much more convenient to take the medicine once a day than three times a day. But it soon became clear that immoderately prolonging the effect of drugs is a vicious practice: the longer the effect of the drug, the sooner addiction develops to it. Sometimes the superdrug stopped working in just a month.

To prevent this from happening, the body needs to rest. Of course, no one discounts the "long-playing" nitroglycerin; in cases of a single dose, it is indispensable. But there is no point in using it all the time.

What to prefer?

VERIFIED that the most suitable medicines are in the middle range. Their validity period is from 3 to 12 hours. Having such an arsenal at its disposal, the cardiologist gets the opportunity to prescribe differentiated therapy. True, it requires certain efforts from the doctor, because in this case each patient needs his own, individual approach. And this, in the conditions that doctors receive a meager salary, we agree, is not always feasible. But let's not talk about sad things.

AT mild form the toad appears only during physical exertion: on the way to work or from work. If the rest of the time there is no pain, then such patients are advised to put a tablet of "short" nitroglycerin under the tongue during the journey (before going out).

But there are other extremes, when an attack can happen from the fact that a person simply turned over in bed. Ten attacks a day cannot be "quenched" with ten tablets. This is where a differentiated approach is needed. 4-5 times a day, the patient needs a short-acting remedy, and 2 times a "long-acting" remedy. It is clear that with such therapy there is a high risk of addiction, and doctors should be aware of this. The main thing is not to miss the moment. The position of the patient is very important here. With a creative approach to his well-being, it will not be difficult for him to notice that the medicine has become worse. And vice versa: if the patient does not really listen to his body, but only takes the pills according to the prescribed scheme, this does not at all contribute to the effectiveness of the treatment process.

Getting used to nitrate means that it is time to gradually reduce the dose and stop it. Not every patient will stand the drug-free test well, and the chronic one may even die. The gap in treatment is closed by drugs or calcium antagonists. Usually "rest" lasts several days.

Today, nitroglycerin is prescribed not only for the relief of seizures, but also for prevention. The latter is a more civilized approach to the disease. Aerobatics in that angina pectoris confirms its existence as rarely as possible. To prevent the medicine is taken in advance. A good test is climbing stairs. If a person cannot rise above the second floor without medicine, and after taking it calmly reaches the fourth, then this is a sure sign that the drug is working well.

Is there a toad?

SCENE from life. In the subway, a person has an attack of vegetovascular dystonia, and those around him immediately put a nitroglycerin tablet under his tongue. As a result, the unfortunate person becomes even worse: the spasm in the head intensifies, the pain becomes even stronger, the pressure decreases - sometimes so much that the person faints.

This is a classic example of a drug being misused.

Far from any pain in chest have angina. The difficulty is that a person cannot always understand what exactly hurts him. A condition similar to an attack of angina pectoris can give vegetovascular dystonia, osteochondrosis, stomach ulcers, cholecystitis. Cardiologists know that in 80% of cases it is not the heart that hurts. But with the remaining twenty percent, the jokes are bad: there are cases when people died from an attack of angina pectoris only because there was no nitroglycerin nearby.

If there is no doctor nearby, then general rule is: any suspicion of heart pain is considered heart pain. Angina pectoris is one of the most common manifestations coronary disease. Better to make a mistake and take nitroglycerin than to be safe and not take it. In the end, its side effects are not so dangerous for the body. The maximum that awaits you if you take nitroglycerin past the target is a headache. It can be stopped with analgin.

Other side effects are dizziness, palpitations, pressure drop (nitroglycerin dilates blood vessels), loss of consciousness. If there is nausea, there is no need to be afraid. Lay the person down, raise his legs, then the vasodilating effect will decrease.

Ideally, you should not treat the heart on your own - this is on the one hand. On the other hand, the diagnosis of angina pectoris is still a weak point for some cardiologists. Often, if the patient is elderly, he is given this diagnosis without looking.

The angina pectoris syndrome was described as early as the end of the 18th century. The description is still relevant today, there is nothing to add to it:

• short-term chest pain;
• the pain may be "blurred" and expressed as a feeling of constriction;
• appears only during physical activity and disappears after its termination.

If a pain appear without connection with physical activity, then the questionnaire becomes negative.

Most typically, angina pectoris occurs in men after forty years, in women - after fifty. In women, before the onset of menopause, angina pectoris, as a rule, does not happen.

Patients are often interested in: is it necessary to grab the medicine right away? If the pain goes away on its own, immediately after stopping physical activity, then such attacks can be waited out. This is the most "beneficial" form of angina that occurs when a person drags a cabinet or pushes a car. Over time, this form gradually turns into a more severe one, when a person cannot reach the toilet without an attack.

If you have removed the load, and the pain does not disappear within one or two minutes, this may indicate an incipient myocardial infarction. Here, of course, a nitroglycerin tablet is required. Other "heart" medicines - Corvalol, Valocordin, Validol, etc. - have no effect on angina pectoris. Therefore, it is useless to use them for stopping seizures.

It's important to know:

• prolonged medicines also give a headache;
• with angina attacks, you can not use red capsules containing an oily solution of nitroglycerin, since the drug from them is absorbed into the blood very slowly;
• nitrosorbide - the name of the domestic nitrate of prolonged action. Calculated for 3-5 hours. It is not inferior to imported analogues.

Doctor D. Merrill, practicing in England in the middle of the 19th century, observed workers breathing vapors of nitroglycerin. As a result, he found that the effect of nitroglycerin on the heart in minimal doses is positive in vascular spasms. Currently, the drug is prescribed for high blood pressure and with excessive stress on the heart muscle.

That life-saving Nitroglycerin

Nitroglycerin is justified when emergency conditions, shown to patients in the departments of gastroenterology, surgery and cardiology. Most often, elderly patients have it in their purse to use for heart pain, sudden attack angina. Nitroglycerin helps to restore the work of the heart muscle with its dysfunction, as well as with hypertension.

Fact on topic! The active component of Nitroglycerin - glycerol trinitrate (pure organic), reduces vascular tone, as a result, the muscle tissue of the vessels relaxes, they expand, and blood flow improves.

As a result, the volume of blood decreases, the pressure of the fluid flowing to the right atrium decreases, the load on the organ becomes less, and accordingly, its work improves. Due to optimal blood flow, metabolism is normalized, oxygen starvation, tissues that have experienced an O2 deficiency work better, the deterioration of myocardial trophism is neutralized.

You can take Nitroglycerin from the heart, with spasm of smooth muscle fibers of the bronchi, narrowing of the gallbladder ducts and deterioration of bile output, with poor bowel function. A tablet of Nitroglycerin will help with high blood pressure (), by acting on the smooth muscles of the vessels, the spasm is relieved, the vascular lumen becomes larger, the blood flow flows freely, the pressure decreases.

Important! At the very first application, orthostatic hypotension may occur. Nitroglycerin for hypotensive patients is indicated for use with caution, you need to start with minimal doses, constantly monitoring blood pressure.

The maximum allowable number of tablets per day is 6 pcs., Drops - no more than 16.

For reference! Orthostatic hypotension may develop as a result of taking Nitroglycerin. There is a sharp decrease in pressure - the upper by 20 units or more, the lower by 10 units. The situation develops when the patient moves from a horizontal to a vertical position, blood pressure drops during the first 3-4 minutes after getting up. Pathology is not an independent disease, due to a change in the regulation of blood pressure.

Taking Nitroglycerin is justified:

1. With severely elevated blood pressure and an attack of angina pectoris.
2. As a preventive measure to prevent paroxysmal angina pectoris in hypertensive patients, before psychophysical stress. It is justified to use Nitroglycerin for people with stable high blood pressure, 2–3 minutes before a walk in the winter season, when climbing a mountain, stairs, etc.
3. With biliary colic, an attack of acute pancreatitis, spasm in the gastrointestinal tract, spastic intestinal dyskinesia.

In the presence of hypertension, taking Nitroglycerin cannot be erratic, it is important to follow certain rules that the attending physician will announce. Only then will the therapy be safe and effective.

Typical Assignment Rules: Schema Explanations

Nitroglycerin dissolves quickly, the active substance (DV) enters the blood and therapeutic effect occurs within the first 2 minutes after administration, the duration of the drug exposure is up to 20-30 minutes.

With psycho-emotional or physical activity, when a heartbeat appears and pain in the heart lasts more than 2 minutes, it is recommended to take 1/2 or a whole sublingual (under the tongue) tablet of Nitroglycerin. In the same doses, the drug is used in capsules.

The undoubted plus of Nitroglycerin is its rapid dissolution, before taking it, it is recommended to take a “sitting” or lying position to prevent dizziness and fainting.

Important application points:

• It is better to start the first intake of Nitroglycerin with half the dose (1/2 table) in order to exclude a negative reaction to the drug. This dose is recommended for people prone to fainting.
• Nitroglycerin is indicated for use in chest pain and the heart at rest. If there is no effect for more than 2 minutes, you can take the dose again 5 minutes after the first dose, but not more than 3 times in a row, an overdose is possible.
• A prolonged attack cannot be ignored and tolerated, since there is a possibility of myocardial infarction, you must immediately call an ambulance.
• In the form of drops, Nitroglycerin is indicated for hypertensive patients. As a therapy, the agent is dripped onto a piece of sugar (2-4 drops) and placed under the tongue until completely dissolved.

In the absence of a reception system, ignoring the doctor's recommendations, there is a risk of a sharp decrease in pressure, collapse, the patient has pallor of the mucous membranes, weakness, nausea.

General list of indications for admission: when you can and cannot

With prolonged use of Nitroglycerin in heart pathologies, the drug loses its effectiveness, this must be remembered and the remedy should be replaced in a timely manner - which one, the cardiologist will say.

Indications for the heart:

1. Angina pectoris and its prevention.
2. Necrotic foci in the myocardium (acute ischemic necrosis).
3. Heart failure.
4. At hypertensive crisis and accompanying pain in the heart.

It is also indicated for pulmonary edema (4 doses in the form of an aerosol, intravenous drip 1% solution), acute pancreatitis, with a decrease in motility of the biliary tract. During operations in the Department of Neurosurgery, Nitroglycerin is used as a means of artificially lowering blood pressure.

Important nuances

Capsules of red Nitroglycerin include an oil solution, so the effect of the main substance of the drug is stretched in time and arterial pressure decreases gradually. This is justified if the patient has a slight increase in blood pressure or there is a risk of an excessive "collapse" of indicators.

With angina pectoris, there is no need to use this form of the drug, it is enough to use traditional sublingual tablets, drops or an aerosol.

With glaucoma or after a stroke, Nitroglycerin cannot be taken on its own, only after a full-time consultation with a doctor and in strictly prescribed doses.

To prevent addiction, you need a break between courses of 30 days.

Nitroglycerin is indicated with caution for hypotensive patients, a strong decrease in blood pressure will put a strain on the heart, provoke headache, dizziness and nausea.

Sometimes there is a disorder of visual functions when taking Nitroglycerin, this can be seen when looking at something dark, located in a white background. The patient notes the appearance of bluish circles along the edges, and yellowish circles in the center.

Nitroglycerin can provoke an increase in intraocular pressure, if this fact is fixed, then the medication is stopped.

Side effects, restrictions and how to store

Nitroglycerin should not be considered a panacea for pain in the heart or hypertension, despite the widespread approval of the drug by doctors and patients. If the dosage is violated, it is easy to "get" the following negative effects:

1. Feeling of dryness in the mouth.
2. Nausea.
3. General weakness, desire to sleep.
4. Weakness is accompanied by dizziness.
5. There may be pain in the abdomen.
6. Visually visible pallor of the mucous membranes and skin.

Individual intolerance to the drug severely limits the intake of Nitroglycerin; in the elderly, the remedy can provoke constipation, then it is combined with gentle laxatives, preferably of plant origin.

• Elevated ICP.
• Hematomas in the head, hemorrhage in the brain.
• Glaucoma and heart attack.
• Pregnancy and HB.

AT childhood the drug is not used.

Store Nitroglycerin in the refrigerator in the "native" container. When opened, the drug quickly loses its properties, after 2 months its effectiveness is 30% lower. With a rare single dose, a medicine in the form of a spray is more suitable.

The price of Nitroglycerin is low, which makes it affordable for patients with different levels income. Available in ampoules (they are more expensive, up to 500 rubles), tablets, capsules, drops, spray.

Based chemical the release of means of prolonged (long-term) action has been launched, the most famous: Sustac (Sustac forte), Nitrong, Erinit, Nitrosorbit. They are taken on the eve of going out into the cold, with the upcoming psychophysical stress.

These funds are able to prevent the onset of angina, which, of course, like patients who are away from home for 3-6 hours.

The biggest disadvantage of prolonged funds is the inability to quickly stop the attack (at least after 20 minutes), so Nitroglycerin in its pure form remains indispensable.

As an exception, Nitrosorbit can be noted, a sublingual remedy that acts 5 minutes after ingestion. But emergency assistance in an acute attack of angina pectoris, nitroglycerin should be stopped.

Long-acting nitroglycerin preparations can be used as therapeutic drugs in the presence of heart failure. Their influence is based on a decrease in the flow of venous blood to the heart, thereby eliminating stagnation in the pulmonary circulation. But such drugs cannot give the heart muscle the necessary strength for good functioning, although they show an adequate response in cardiac asthma and the weakening of its attacks.

Facts on the subject! Currently, developments are underway to create more modern drug, well stopping pain in angina pectoris. But so far no substance has been found that could adequately replace Nitroglycerin.

Patients with "chest pain" make up about 20% of all hospital admissions. For many years, it has been widely believed that the relief of chest pain with nitroglycerin is diagnostic criterion ischemic heart disease (CHD). Many clinical guidelines mention that the relief of chest pain with nitroglycerin is of great diagnostic value. However, there are a significant number of conditions associated with chest pain, and only a small number of these patients actually have angina or acute coronary syndrome. Many of these conditions may respond to nitroglycerin, for example, pain with spasm of the esophagus, etc. In addition, pain in IHD is not always relieved by nitroglycerin, which also reduces the significance of the test.

Dr. Charles Henrikson and colleagues from Johns Hopkins University, Baltimore, USA conducted a prospective observational study to find out whether the relief of chest pain with nitroglycerin is a reliable diagnostic criterion for CAD.

The study included patients who were consecutively admitted to admission department Medical Center Johns Hopkins complaining of chest pain. Nitroglycerin was taken at a dose of 0.4 mg sublingually in the form of tablets or spray under the supervision of the medical staff of the department or mobile team. Pain was assessed on a 10-point scale immediately before and 5 minutes after taking nitroglycerin. During an attack of pain, an ECG was performed.

Chest pain was classified as 'responsive to nitroglycerin' if pain intensity was reduced by at least 50% after the first dose of nitroglycerin.

The study included 459 patients. In 39% (181 patients) the pain was relieved by taking nitroglycerin, in 61% (278 patients) it was not relieved.

The study collected more detailed information about the patients in order to determine whether the cause of chest pain was an exacerbation of coronary heart disease.

The criteria for an exacerbation of coronary artery disease were considered appropriate symptoms in combination with at least one of the following indicators: elevated level serum troponin T, stenosis of the coronary arteries by 70% or more according to angiography, a positive stress test, a diagnosis of exacerbation of coronary artery disease, established by the attending physician during hospitalization.

In 31% (141) of patients, the cause of chest pain was an exacerbation of coronary heart disease, 60% (275) of patients did not have an exacerbation of coronary artery disease. In 9% (43) of patients, according to different reasons it was impossible to determine the cause of the pain.

In the group of patients in whom the cause of pain was an exacerbation of coronary artery disease, only in 35% (49/141) of cases, pain was relieved by nitroglycerin. On the contrary, in the group of patients without exacerbation of coronary artery disease, pain was relieved by nitroglycerin in 41% (113/275) of cases.

Thus, the sensitivity of the test in relation to the diagnosis of coronary artery disease was only 35%, the specificity was 59%.

On the ECG performed during an attack of pain, there were no significant differences between the groups of patients who responded and did not respond to nitroglycerin (p>0.2). In addition, there was no statistically significant difference between these groups in terms of mortality, subsequent development of myocardial infarction, coronary revascularization.

The results of the study demonstrated the absence of diagnostic and prognostic significance of relief of chest pain with nitroglycerin and showed that this test should not be taken into account when choosing therapy tactics in a hospital setting.

The data obtained in this study refute the common opinion about the significance of pain relief with nitroglycerin for the diagnosis of coronary artery disease. However, it should be borne in mind that only urgently hospitalized patients were included in the study, and the results of the study cannot be unequivocally extrapolated to the outpatient setting. The causes of chest pain in patients treated in inpatient and outpatient settings are largely different, as are the mechanisms for the development of myocardial ischemia. Therefore, a positive response to nitroglycerin is still important. diagnostic sign in outpatient practice, at least until more research is done.

C.A. Henrikson, E.E. Howell, D.E. Bush et al.

Chest Pain Relief by Nitroglycerin Does Not Predict Active Coronary Artery Disease

Ann Intern Med 2003; 139:979-86

chest pain, nitroglycerin, ischemic heart disease, ischemic heart disease, diagnostic criterion

Currently, the shelves in pharmacies are simply bursting with the amount of medicines that are stored on them. You can buy many drugs only with a prescription from a doctor, but most of the products from the existing range will be sold without one. Nitroglycerin also belongs to freely sold medicines. From what it helps, you can find out from this article. Despite its popularity, it should be treated with extreme caution.

Information about the drug

Nitroglycerin (a group of nitrates) quickly found use. It began to be used at the end of the 19th century, after the discovery by the Italian Ascanio Sobrero. At first it was the production of explosives.

After a long observation of workers in the production shops, the doctor Merrill concluded that nitroglycerin vapors have an effect on human health.

A little later, it was found that this substance can also be used for medical purposes for the treatment of certain diseases. For example, after taking it, it is possible to relieve spasm of the heart vessels. When a few drops of the drug were enough to stop it.

So gradually nitroglycerin began to be used in medical practice.

Today, if you ask any person about "Nitroglycerin": "What should it be used for?", then almost everyone will say that it is indispensable for heart attacks. No other medicine has yet been invented that would so quickly relieve the pain of angina pectoris.

Forms of release of the drug

"Nitroglycerin" can be attributed to those grandiose discoveries in the world of pharmacology, which happen infrequently. During its use, and this is already more than 100 years, they have not invented more effective medicine from "angina pectoris".

Manufacturers produce its various forms and packaging, but the active ingredient remains the same. Now in pharmacies you can find a fairly large assortment. "Nitroglycerin" is produced in the form of tablets that must be placed under the tongue. This is the very first form of release of the drug.

Now the nitroglycerin patch has become fashionable, which is enough to stick to the skin or mucous membrane for the active substance to begin its healing work. Even more advanced is the Nitroglycerin Aerosol. Despite the fact that all these preparations contain the same substance, their cost can vary widely.

"Nitroglycerin" - mechanism of action

Many people are probably wondering what is the secret of such an instant effect of this medicine in heart attacks. The whole answer lies in the principle of the drug. Pain in angina occurs as a result of an acute oxygen deficiency in the heart muscle. There are only a few ways to remove it:

1. Increase the flow of oxygen to the heart.
2. Decrease heart rate and force to reduce oxygen consumption.

All this is quite capable of carrying out "Nitroglycerin". After taking it, the production of nitric oxide increases, which dilates blood vessels, especially veins. This leads to the fact that the flow of venous blood to the heart muscle decreases, and the frequency of contractions and their strength decrease. If there is less work, then less oxygen is required.

But the medicine "Nitroglycerin" also increases the supply of oxygen to the heart by expanding coronary vessels, and this happens more strongly at the site of ischemia, which leads to a rapid relief of an angina attack.

The effect of taking the medicine can be observed after a few minutes. The drug is also quickly expelled from the blood. After 40-45 minutes, there will be no trace of him.

Indications for use

There are a number of diseases in which "Nitroglycerin" is recommended. The application may require a one-time or long-term application. Among the indications are the following:

• Any manifestations of angina pectoris.
• which can complicate intravascular studies.
• Myocardial infarction, especially against the background of hypertension.
• Heart failure.

• Before neurosurgical operations, "Nitroglycerin" can be used. The use of it will artificially reduce the pressure.
• Spasm of the arteries in the retina of the eyeball.
• Dyskinesia of some parts of the digestive system.

When else can you take Nitroglycerin?

It turns out that this medicine can be used not only in moments of heart pain, but also in some other cases. For example, to prevent an attack, if you have physical work to do or emotional stress is foreseen.

Often it is taken by patients diagnosed with angina when they climb the stairs to the top floor of a multi-storey building. It is recommended to take it before climbing the mountain, especially in winter, frosty and windy weather.

You should not be surprised if the doctor prescribes "Nitroglycerin" during attacks of pancreatitis or biliary colic. The prescription is in Latin, but the pharmacists in the pharmacy are well versed in such records. This appointment can be explained by the fact that this drug perfectly relieves spasm of the smooth muscles of the gastrointestinal tract.

Proper medication intake

Despite the great popularity of this drug, it must be remembered: it is still a medicine, so it must be taken according to certain rules. Only then can security be guaranteed.

The most efficient and fast way help is a Nitroglycerin tablet placed under the tongue. Since there are many blood vessels, the medicine is almost instantly absorbed into the blood, and relief comes.

If you decide to take a Nitroglycerin tablet, then before that it is better to sit down. Some may feel dizzy, and in exceptional cases there are fainting spells.

In old age, it is better to take it in the supine position. At the time of the attack, the pill should work in a couple of minutes. If the pain does not let go, then you can take another one. If after 15 minutes the pain does not go away, then you will have to call a doctor, otherwise not far from

If in your first aid kit "Nitroglycerin" in the form of drops, then during a heartache, you can drop 2-4 drops on a piece of sugar and keep it under the tongue until it dissolves. Some manage to drip directly onto the tongue or even lick the vial from the cork.

You should not self-medicate, even if you are familiar with Nitroglycerin. From what it is recommended to use - you know, but the wrong dosage is fraught with serious consequences.

Varieties of "Nitroglycerin"

Everyone knows that this drug acts quickly, but not for long. At present, forms have been created that are able to exert their therapeutic effect for several hours. These drugs include prolonged nitroglycerin, such as Sustak, Nitrong, Trinitrolong.

They are recommended to be applied in advance, they are able to prevent the occurrence of an attack for several hours. Active substance- nitroglycerin - begins to gradually enter the bloodstream, thereby these drugs are many times longer than their original "brother" in terms of duration of action.

Along with this advantage, they are still inferior in speed of action, and this is very important at the time of the attack. This is due to the fact that they are not placed under the tongue, but washed down with water, respectively, it takes a certain time for the medicine to dissolve and be absorbed into the blood.

Therefore, if an attack overtook you suddenly, you can not do without the usual "Nitroglycerin" in the form of sublingual tablets.

Side effects

Anyone medicinal product You can always find side effects. They are indicated in the annotation to the medicine. This, of course, does not mean that this or that effect will manifest itself in you, but you need to know about them.

The side effect of "Nitroglycerin" can be explained by the fact that it dilates blood vessels. The following common side effects can be listed:

Long-acting forms of this drug can cause the same side effects. It is worth noting that with prolonged use of them, addiction begins to develop, therefore side effect"Nitroglycerin" and its forms are significantly reduced or completely disappear.

Frequency of taking the drug

Those patients who suffer from heart attacks often try to endure the pain and do not take Nitroglycerin. But that won't help in this situation. If the attack is not stopped, then the pain may increase, then it will be much more difficult to eliminate it.

In severe situations, some patients may take more than 50 tablets during the day. Doctors consider such a dose in certain situations to be quite reasonable.

Most scientists who are researching this drug believe that the constant use of it can lead to the opposite effect - an increase in the frequency of attacks and their strength.

Therefore, to the question of whether it is possible to take "Nitroglycerin", the answer suggests itself only positive, but still you should not do this without a doctor's recommendation and in large doses.

Contraindications for admission

Each drug always has its own list of contraindications, so do not rush to go to the pharmacy and buy medicine without a doctor's prescription.

"Nitroglycerin" in any form is categorically contraindicated in the following diseases:

• Low pressure.
• Anemia.
• Acute myocardial infarction.
• Circulatory problems.
• Pulmonary edema.
• Glaucoma.
• Alcohol intoxication.
• Stroke.
• Heart defects.
• Pregnancy.
• Problems with the thyroid gland.
• Renal and liver failure.

You should not take Nitroglycerin if you are being treated with Sildenafil.

If you have a history of taking "Nitroglycerin" is contraindicated, then it is advisable to discuss with your doctor what drugs you can take in this case.

Poorly tolerated "Nitroglycerin"

Some, after taking the medication, feel a sharp headache, dizziness, and begin to believe that this drug simply does not suit them. But this is due to its vasodilating effect. With repeated use, this may not happen, or these symptoms will appear more mildly.

If every time you take it you feel bad, you experience severe pain in the head, then it is worth discussing with the doctor the appropriateness of using this remedy.

With frequent attacks of angina pectoris, this drug is the only one that can save you at a critical moment, so you should not immediately abandon it at the first manifestations of side effects. Try lowering your dosage and discuss the situation with your doctor.

Storage conditions

After purchasing any medicinal product it must not only be taken in accordance with the instructions or recommendations of the doctor, but also stored under certain conditions. "Nitroglycerin" should not be left in the light. Under its action, it quickly begins to collapse, the same thing happens in a warm place.

To prevent this, this medicine must be stored in the refrigerator. If your doctor prescribed "Nitroglycerin" (prescription in Latin), the instructions that come with it will be enough for you. You can read about all storage requirements there.

In the instructions, you can see such an item that recommends storing "Nitroglycerin" in the packaging in which it was sold. This can be explained by the fact that the vial and cotton wool are treated with a special composition, which helps to preserve the properties of the drug.

After you have uncorked the package, "Nitroglycerin" and subject to all storage conditions cannot retain its medicinal qualities for a long time. In a couple of months, its effectiveness will drop by 30%. In this regard, capsules are more stable.

If you use this medicine often enough, then tablets are quite suitable, and if rarely, then it is better to purchase a spray that has a long shelf life.

If you don’t want to take a whole vial or pack of pills with you on the road, and you decide to wrap a few pieces in a napkin and put them in your purse, then you don’t even have to try, after such transportation the drug will not help you.

Despite the fact that most of us know what "Nitroglycerin" is, what it helps from, it does not hurt to once again recall the features of its use:

1. Do not be afraid of a sharp headache after taking the drug, this indicates that the medicine has begun its work. After a few techniques, such sensations will cease to bother you.
2. If you suffer from angina pectoris, then "Nitroglycerin" should always be at your fingertips.
3. In case of heart attacks, it is advisable not to use the capsules, they contain an oily solution that takes longer to be absorbed.
4. If you take medicine long time, then the effect of it is sharply reduced, so you need to take a break.
5. In the presence of eye diseases, Nitroglycerin should be taken with extreme caution.
6. When receiving this medicine it is better to postpone, otherwise it may fall even more, and the person will lose consciousness.

No one doubts the miraculous effect of "Nitroglycerin", because it is not for nothing that more than 100 years, scientists have not been able to invent more effective drug from angina. But despite all this, the reception must be carried out strictly on the recommendation of a doctor in compliance with all dosages, so as not to harm your health.