Nitroglycerin is a life-saving drug for heart disease!

That's right!

But inaccurate, heart disease is all-encompassing, nitroglycerin is only a life-saving drug for coronary heart disease, and it is a proper life-saving drug for angina attacks in coronary heart disease.

First, life-saving drugs

When angina pectoris attack, it is because of myocardial ischemia caused by narrowing of the blood vessels in the heart, and myocardial hypoxia causes angina pectoris; nitroglycerin has the effect of dilating blood vessels, and when the blood vessels are dilated, the ischemia and hypoxia of narrowed blood vessels will be improved, and angina pectoris will be relieved. If not relieved in time, severe angina will induce cardiac arrest.

Nitroglycerin is virtually the only angina first aid, effective in 93% of angina attacks, with an onset of action in about 2 minutes, and is the most commonly used first aid for coronary heart disease.

Second, effective judgment

Angina pectoris typically lasts 3-15 minutes per episode, and the criteria for drug effectiveness/

1, apparent effect: within 3 minutes after the drug, angina disappeared or basically relieved.

2、Effective: angina disappeared or basically relieved in 3~5 minutes after administration.

3、Ineffective: angina is gradually relieved or not improved for more than 5 minutes after administration.

If it takes more than 5 minutes to get relief after containing it, either the drug itself is not useful and it is not coronary angina per se, or the angina itself lasts for a relatively short time and has been relieved on its own.

Third, a lot of friends message and rumors that acute myocardial infarction when the rush to contain nitroglycerin :

1, acute myocardial infarction containing nitroglycerin is difficult to relieve symptoms;

2, acute myocardial infarction is often combined with low blood pressure, shock, containing the end will aggravate hypotension, such as acute lower wall right ventricular myocardial infarction, such as acute extensive anterior wall myocardial infarction accompanied by cardiogenic shock, these cases if the use of nitroglycerin will exacerbate the condition, absolutely can not use nitroglycerin;

3、How do you determine that it is an acute myocardial infarction? Chest pain is always acute cardiac condition is it? Pulmonary embolism will also chest pain, aortic dissection will also chest pain.

Fourth, common side effects:

With nitroglycerin, some people will experience...

1 Headache: may occur immediately after administration, may be severe and persistent.

2 Vertigo, weakness, palpitations, and other manifestations of postural hypotension may occasionally occur, especially in upright, braked patients.

3 Significant hypotensive reactions may occur at therapeutic doses, as evidenced by nausea, vomiting, weakness, sweating, pallor, and defecation.

4 Syncope, flushing, drug rash and exfoliative dermatitis have been reported.

Fifth, Nitroglycerin is contraindicated.

1、Acute lower wall right ventricular myocardial infarction; this time contains the service what also has no effect, only as soon as possible to open the blood vessel is the king;

2. Severe anemia;

3. Glaucoma;

4. Increased intracranial pressure

5. Patients who are allergic to nitroglycerin;

6. Hypertrophic obstructive cardiomyopathy;

7. Low blood pressure;

Correct recommendation.

Have a clear history of coronary artery disease and take 1 capsule of nitroglycerin by mouth immediately when an attack of angina occurs, but need to see a doctor as soon as possible.

If it is effective, but recurrent episodes can be repeated, the theory is that if the blood pressure is not low, you can continue to take it.

In short, nitroglycerin is only an emergency, and a combination of medications, or stents, or bypasses, are needed to address the root cause of angina.

Angina pectoris, a clinical syndrome mainly characterized by chest pain caused by temporary myocardial ischemia, is one of the most common manifestations of coronary heart disease. When it comes to angina pectoris, it is not only sudden and painful, but also life-threatening if not treated in time.

Angina attacks are mainly characterized by retrosternal pain that radiates to the precordial area and the left arm, and sometimes the attack site can be "deviated". The attack may be characterized by a feeling of crushing pain or tightness, or even a feeling of suffocation. Regardless of the type of angina pectoris, the primary goal of treatment during an attack is to improve myocardial ischemia and relieve painful symptoms.

Nitroglycerin is one of the classic and commonly used drugs to prevent and treat angina of coronary heart disease, which has a fast onset of action, a short duration of action, is easy to take and reasonably priced, and many elderly people carry it as a life-saving drug at critical moments.

But did you know? Nitroglycerin, if used improperly, not only fails to stop an angina attack, but also aggravates the condition.Next, the pharmacist will tell you more about the precautions for the use of "nitroglycerin tablets"!

Why must nitroglycerin tablets be taken sublingually?

Nitroglycerin tablets are poorly absorbed orally. The drug enters the gastrointestinal tract and is metabolized in the liver before it is absorbed into the blood circulation, making the amount of the drug in its original form that enters the blood circulation reduced and less effective.

Nitroglycerin tablets are usually administered sublingually, which can be immediately absorbed into the bloodstream through the sublingual capillaries, with an onset of action in 2-3 minutes, maximum effect in 5 minutes, and a duration of action of 10-30 minutes.

Nitroglycerin tablets, when to take them? How do I take them?

Nitroglycerin tablets for emergency use in angina attacksIt is not required to be dosed daily, and it is mainly used as an emergency remedy in case of angina pectoris attack. For patients with a history of coronary angina, it is recommended to carry it with you to be prepared.

Take one tablet under the tongue at a time during an attack, and if the pain is not relieved after 5 minutes, another tablet can be taken every 5 minutes, but it should be noted that if the total number of tablets taken within 15 minutes reaches 3 but the pain still persists, you should go to the hospital immediately.

You may take one dose beforehand when you may have to perform physical labor or when you are emotionally excited.Especially in elderly patients prone to angina, prophylactic use 5-10 minutes before activity or bowel movement can avoid inducing angina.

What are the precautions when taking nitroglycerin tablets?

Sit as much as possible while taking it sublingually.Nitroglycerin relieves myocardial ischemia by dilating blood vessels, and therefore may cause hypotension. If you have ever experienced nausea, vomiting, weakness, or sweating after taking the medication, you need to be careful to remain seated while taking the medication so that you do not suddenly become dizzy and fall down while standing up. In addition to low blood pressure, adverse reactions such as headache, flushing, and reflexive increase in heart rate may also occur.

High doses of nitroglycerin may further exacerbate angina.Remember! Go to the hospital immediately if there is no relief after 3 tablets have been contained within 15 minutes.

Nitroglycerin tablets are intended to be taken only in acute attacks of angina pectoris.frequent use over a long period of time may lead to drug resistance, theResistance is characterized by a weakening of the pain relief effect. In order to avoid the development of drug resistance, when using nitroglycerin, it is necessary to ensure that there is a sufficient period of drug-free time, which is also known as the "blanking period", and the blanking period for nitroglycerin tablets should be at least 8-12 hours.

What kind of patients should not take nitroglycerin tablets?

The following patients should not take nitroglycerin tablets:Patients with severe hypotension and tachycardia in the early stages of infarction, severe anemia, glaucoma, increased intracranial pressure, hypertrophic obstructive cardiomyopathy, and sildenafil use.

Another study has suggested that nitroglycerin may not be as effective in people who drink and blush easily.

This is because nitroglycerin breaks down and releases nitric oxide, which causes a series of reactions to dilate blood vessels. People who blush easily after drinking alcohol lack the enzyme acetaldehyde dehydrogenase 2, which not only breaks down alcohol, but also promotes the breakdown of nitroglycerin. This group of people cannot effectively break down nitroglycerin and therefore cannot reap the benefits of the treatment.

How are nitroglycerin tablets stored?

:: People with angina should carry nitroglycerin tablets with them at all times, but it is best not to carry the medicine in a close-fitting shirt pocket because it breaks down easily when exposed to temperature.

● Nitroglycerin tablets need to be kept out of the light and the bottle itself, which is dark brown in color, should also be kept at about 20°C in a place that is not exposed to sunlight.

● Nitroglycerin tablets need to be stored in a tightly sealed bottle and capped promptly after use. This will prevent the medication from becoming ineffective.

● When keeping medicines at home, it is recommended to discard nitroglycerin tablets that have not been used for six months after opening and replace them with a new bottle.

Long-term treatment of stable angina pectoris

Nitroglycerin is a fast-acting drug and is indicated for acute attacks of angina. Long-acting nitrates, which are common in clinical practice, are suitable for chronic long-term treatment due to their slow onset and prolonged duration of action, and can reduce the frequency and extent of angina attacks and may increase exercise tolerance.

For example, isosorbide mononitrate extended-release tablets, administered once a day, have an action lasting 12 hours. Exertional angina is prone to attacks during the daytime at work, and the drug is taken once in the morning, with high blood levels during the day and a gap period at night to avoid drug resistance.

Lifestyle changes

Quit smoking! Quit smoking! Quit smoking! The nicotine in cigarettes damages the endothelium of the blood vessels, which are already fragile and can't withstand the successive stimulation of nicotine.

Secondly, good eating habits and happy mood is also very important, to keep "eating not hungry, not support just full, the mood is calm and stable not angry. According to the need, the right time, the correct use of drugs, so that drugs for health escort!

This answer was provided by Zhou Xin, Pharmacist, Department of Pharmacy, Beijing Chaoyang Hospital, Capital Medical University!

First of all, it should be clear that sublingual nitroglycerin tablets are only suitable for patients with coronary heart disease angina pectoris acute attack used to relieve the symptoms of emergency drugs.

Episodes of stable angina are often associated with exertion, so walking too much during the day, too fast, going up stairs, lifting heavy objects, overexertion related to rest or sublingual nitroglycerin soon relieved. Typical symptoms are the sudden onset of severe strangulation, tearing, cutting pain in the middle and lower 1/3 of the sternum, and a few of them only show a mild degree of sudden chest tightness, shortness of breath, some of them are accompanied by pain in the throat or the left shoulder and arm, and at the same time, there is a kind of asphyxia or sense of imminent death. The cause of its occurrence and the coronary artery atherosclerotic plaque increased coronary blood supply decreased, can not meet the obvious increase in myocardial oxygen consumption during exertion and caused.

Unstable angina belongs to the non-myocardial infarction type of acute coronary syndrome, which occurs when unstable soft plaque ruptures and activates platelet aggregation to form a thrombus, and myocardial ischemia occurs when the lumen of the vessel narrows. As thrombus formation also activates the body's own antifibrinolytic system to dissolve the thrombus, the rate of thrombolysis is better than the rate of thrombus formation, i.e., the thrombus fails to completely block the lumen of the blood vessel is unstable angina pectoris. It can be manifested as incipient angina pectoris, worsening angina pectoris, recumbent (resting) angina pectoris, variant angina pectoris produced when emotional excitement, myocardial infarction short-term reoccurring angina pectoris. Sublingual nitroglycerin is effective but not as effective as exertional angina. And last 15-20 minutes without relief is likely to evolve into myocardial infarction.

There are too many people with "chest pain" because it is easy to link it to coronary angina. However, patients who develop coronary angina often have several risk factors of their own: a family history of cardiovascular disease, a history of smoking, long-term poorly controlled hypertension, hypercholesterolemia, and a history of diabetes. Therefore, people with several risk factors, older age, and especially those who experience typical angina for the first time, should take nitroglycerin (usually not on their own, but can be borrowed from others) and go to the hospital emergency room immediately, because you don't know how the condition will evolve later, or even sudden cardiac death.

The nerves of the myocardium are painless to pinprick, but are particularly sensitive to the stimulation of lactic acid. The heart itself contracts and diastoles about 100,000 times a day, which produces a lot of lactic acid (like soreness in the calves the next day after climbing a mountain), relying on the abundant blood supply of the coronary arteries, if the coronary arteries are narrowed, thrombosis leads to the buildup of lactic acid, and the demand for myocardial blood supply increases even more after exertion and thus angina pectoris is produced. Nitroglycerin sublingual fast absorption and delivery to the coronary arteries and systemic arteries and veins, due to the release of a large number of nitric oxide role in the vascular sulfhydryl, so that the coronary arteries rapid expansion to improve the blood supply of the heart, and at the same time expand the systemic arterial, static veins and reduce the return of the heart's blood volume, thus reducing the heart to reduce the contraction of the oxygen consumption, to alleviate angina pectoris through a dual role.

Two final points are emphasized:

1. No disease prevention is fundamental, whether or not there is a family history of smoking cessation, weight control, exercise and the establishment of a good pattern of life and maintain a good state of mind the most effective measures to stop the three highs, even if it occurs must pay attention to and persistent treatment.

2. Angina must be treated immediately, the kind of treatment program can run a few hospitals to listen to a variety of opinions before deciding, don't miss it.

2018.10.20

Nitroglycerin is a commonly used drug for angina, and because of its special therapeutic effects, it is regarded as a "life-saving drug" by many people! Nitroglycerin's dilating effect on coronary arteries makes it effective in relieving angina pectoris, and today we're going to learn how to take nitroglycerin correctly.

I. Determining the need to serve

Only angina pectoris requires nitroglycerin, other diseases do not require the use of nitroglycerin, so, as far as possible, determine the onset of the disease and find out whether it is angina pectoris or not, if it is another disease, there is no need to take nitroglycerin!

II. Emergencies to be contained

Nitroglycerin can be taken orally, and there are also intravenous preparations, but because of the need to establish intravenous access! So, the rapid onset of action is still under the tongue, where it is rapidly absorbed, while other methods have a later onset of action than the sublingual!

III. Excluding contraindications before taking

Lower wall infarction, often because of insufficient volume caused by low blood pressure, or sometimes long-term heart disease patients, because of its cardiac insufficiency, it is often combined with low blood pressure, and nitroglycerin can be further aggravated by the drop in blood pressure, so the state of low blood pressure, glaucoma and other contraindications need to be ruled out before you can take!

Fourth, take care of the body position

The use of nitroglycerin often causes hypotension, and coronary heart disease is extremely prone to acute syncope and other conditions, so the use of nitroglycerin, as far as possible, to avoid taking it while standing, it is recommended to lie down or lying down when containing!

V. Can be taken again if it does not work

If it doesn't work after containing it, you can increase the dose again, but if the symptoms are still not relieved, you need to consider the possibility of myocardial infarction or other diseases! It is recommended to contact the hospital as soon as possible!

Nitroglycerin is a miracle drug, but it needs to be used correctly, don't you think? Kiss?

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Nitroglycerin we all know that this drug is an emergency medicine, the heart is not comfortable when you can eat, but for the real range of indications for this drug, and which cases do not eat nitroglycerin, how to take nitroglycerin when there are acute symptoms, a lot of people do not understand very well, today we will talk about the application of nitroglycerin with you.

Drug mechanism of action of nitroglycerin

Talking about a drug, to understand how it is applied and what to look for in its application, we may want to start by understanding its mechanism of action.

Nitroglycerin the main role of this drug is - relaxation of vascular smooth muscle, its mode of action is very simple but effective, mainly through the release of NO, causing a series of biochemical reactions in vivo, thus regulating the contraction state of smooth muscle, to achieve the role of relaxation of vascular smooth muscle, nitroglycerin this drug, can dilate the venous vascular bed, can also dilate the arterial vasculature. It can also dilate arterial vasculature, for epicardial coronary artery branches also have a certain dilatation effect, therefore, can effectively reduce myocardial oxygen consumption, relieve angina pectoris.

Nitroglycerin applications and dosage methods

From the mechanism of action can be seen, the main indications of nitroglycerin, is to relieve coronary heart disease caused by angina pectoris, rather than cardiac discomfort can take nitroglycerin, especially for acute infarction in the early stages of patients, accompanied by low blood pressure and tachycardia, it is strictly prohibited to take nitroglycerin to alleviate the condition, do so in addition to not alleviate the condition, but instead, it may be life-threatening.

In addition to this, nitroglycerin should not be taken to relieve angina in patients with glaucoma, severe anemia, and increased intracranial pressure.

For angina caused by coronary heart disease, usually sublingual sublingual 1 tablet, 3~5 minutes can be effective, 5 minutes later can be added a piece, such as 15 minutes, the pain symptoms are not relieved, should immediately seek medical attention.

It is important to emphasize that this medication is to be taken under the tongue and not swallowed. It is absorbed immediately under the tongue and has the fastest onset of action. Swallowing it does not provide fast relief from angina pectoris.

Possible Nitroglycerin Side Effects and Other Precautions

The side effect of headache may occur immediately after nitroglycerin is taken, in addition, due to the vasodilating effect of nitroglycerin, it may produce symptoms related to upright hypotension, such as weakness, dizziness, fatigue, palpitations, etc. In addition, other adverse reactions may include nausea, sweating, pallor, and weakness, etc., all of which may be the reaction of low blood pressure induced by the administration of the drug.

Therefore, when taking sublingual nitroglycerin, care should be taken to try to take a prone position to avoid problems such as fall injuries occurring in upright hypotension. In addition, for those who drink a lot of alcohol and those who have taken sildenafil (Viagra), it is not advisable to take nitroglycerin, so as not to cause serious life-threatening hypotension.

In addition, nitroglycerin should be taken in as low an effective dose as possible, not in large doses for acute episodes of illness. Large doses may induce bradycardia and aggravate angina pectoris, and an overdose of the medication may even trigger severe hypotension and other related problems that can be life-threatening.

If you cannot get relief after taking a low dose and it still does not work after taking 2 doses, you should seek medical advice as soon as possible.

I'm Dr. Small Eyes.

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This is a particularly good question. For patients with coronary artery disease who have sudden acute myocardial infarction, the most effective way is to dilate the blood vessels.

For the average home patient today, the most effective method is nitroglycerin.

But most patientsNot being particularly clear about the use of nitroglycerin, not really utilizing the correct effects of nitroglycerin

Precautions for taking nitroglycerin

It is best to sit down or squat against a wall while relaxing your belt when taking nitroglycerin.

Because.Nitroglycerin can dilate small veins throughout the body, sitting down while relaxing the belt can prevent blood pressure from dropping, avoiding dizziness or even fainting.

But lying flat on your back can increase the amount of return blood and aggravate the heart, so when taking nitroglycerinFlat lying should be avoided

2. The position of the tablet should be under the tongue.

Nitroglycerin is absorbed through the mucous membranes of the mouth and can enter the blood circulation directly for rapid effect.

stillIf nitroglycerin is swallowed, the drug is absorbed and travels through the portal vein to the liver, where some of the nitroglycerin will be inactivated by the liver and the concentration of nitroglycerin in the systemic circulation will decrease.

This not only makes the action of nitroglycerin prolonged, but also reduces the effect of nitroglycerin.

3. The effect of a contained dose should be a burning sensation.

The flavor of nitroglycerin is slightly sweet with some irritation when held under the tongue.

Sublingual nitroglycerin should be digested quickly; if nitroglycerin is taken for too long, it will inactivate the drug.

This leads to taking it for a longer period of time, which in turn delays the condition.

4.The amount of medication taken should be gradual.

You should take half a tablet for the first time and then gradually adjust the dosage.

Generally speaking, half a tablet or one tablet of nitroglycerin for half a minute or two minutes will be effective.

If the effect is not obvious, you can take 1 more tablet in 5 minutes.

If 3 tablets in a row, but can not dog relief symptoms, may be myocardial infarction, you need to call 120 immediately, immediately go to the regular hospital for medical treatment.

5. Never use as little as possible or simmer as long as you can

A good number of patients are concerned about developing resistance to taking nitroglycerin and try to use it sparingly, or not at all, with each attack.

This is very dangerous because each heart attack braces the risk of a cardiac event.

If oral nitroglycerin is not taken in time, it may lead to the risk of myocardial infarction.

6. Drugs should be stored away from light

To maintain its effectiveness, nitroglycerin should be kept in a brown bottle.

Nitroglycerin should be taken within one year of its shelf life to avoid expiration.

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For patients with a history of heart disease (angina) (previous angina) before the heart disease (angina) has not yet attacked go to a regular hospital to find a specialist for further diagnosis and treatment, and actively cooperate with the specialist to improve the heart disease (angina) related examinations, and let the specialist according to their own clinical manifestations of heart disease (angina) and the results of the relevant examinations to formulate the appropriate treatment plan (including when the heart disease). (including how much nitroglycerin should be taken in the first place when angina pectoris attack occurs, and how to take it in order to maximize the therapeutic effect of nitroglycerin).

Second, patients suffering from heart disease (angina) should always carry nitroglycerin, nitroglycerin in their most familiar parts of the body, so that a heart attack (angina), will be able to find nitroglycerin in a very short period of time and take it immediately, for the rescue of myocardial cell necrosis to fight for the precious time, greatly reducing the number of necrotic myocardial cells, and even for the salvation of patients' lives! It bought so much time.

Thirdly, when you suddenly feel a heart attack (angina), lie down on the sofa hurriedly, take out the nitroglycerin immediately according to the first dose as stated by the specialist doctor in the regular hospital, open your mouth with your tongue rolled up, then put the nitroglycerin tablet at the vein at the low level of your tongue, and finally close your mouth and lie down quietly, so that the nitroglycerin tablet will melt away slowly at the vein at the low level of your tongue and be absorbed by the vein at the low level of your tongue.

Finally, when you take nitroglycerin tablets, you should follow the instructions and start taking the smallest dosage from the instructions because: the role of nitroglycerin in expanding the coronary arteries is released faster, the effective period is shorter, which is easy to cause a sudden expansion of the coronary arteries, causing a sudden drop in blood pressure, leading to the occurrence of hypotensive shock, which can cause serious damage to the heart, and it may also lead to the expansion of coronary arteries and the subsequent thrombus There is also the possibility that after the expansion of coronary arteries blood clots may fall off, leading to thromboembolism in other parts of the body (such as pulmonary embolism directly life-threatening, cerebral infarction leading to paralysis, etc.), so the taking of nitroglycerin tablets must be started from the smallest possible dose, in order to prevent the coronary arteries from suddenly expanding to cause low blood pressure and shock, and coronary artery thrombosis and embolism to the rest of the body to cause the corresponding complications. At present, in addition to nitroglycerin tablets, there are also nitroglycerin extended-release tablets, the difference is, and nitroglycerin extended-release tablets it's slow release, slow onset of action, long validity period, will not lead to the occurrence of hypotensive shock, caused by coronary thrombus dislodgement of the possibility is also small, but can only be used to prevent angina pectoris attack, and is not applicable to the heart disease (angina pectoris) of the treatment of an acute attack!

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Not all milk is called Tresor, which is a fitting tagline.

Not all heart attacks require nitroglycerin.

Nitroglycerin is a kind of drug that expands the coronary arteries and systemic veins, and the coronary arteries are specialized in supplying blood to the heart, so expanding the coronary arteries can bring more blood to the heart, and it is correct to use nitroglycerin when the coronary arteries of the heart are narrowed. For example, angina pectoris, myocardial infarction, etc., whether it is angina pectoris, or myocardial infarction, all belong to a kind of coronary heart disease, coronary heart disease is coronary atherosclerotic heart disease, so, this disease with nitroglycerin is a matter of course. For example, a patient with coronary heart disease, suddenly chest pain, this time is likely to be angina pectoris or myocardial infarction, you can consider using nitroglycerin.

But a patient with chest pain doesn't necessarily have coronary artery disease. It could be rheumatic heart disease, it could be hypertrophic cardiomyopathy, it could be acute pericarditis, it could be aortic coarctation, it could be pulmonary embolism, it could be pneumothorax ．．．．．

Nitroglycerin is not suitable for any of the possible ailments mentioned above, and it may not be effective or even counterproductive.

So, the prerequisite for using nitroglycerin is that you have to know that you have coronary artery disease.

Is nitroglycerin appropriate for all patients with coronary chest pain? No. ！！！！！

Coronary angina, it is best to measure a blood pressure, if the blood pressure is low, then do not use nitroglycerin, because this drug will make the blood pressure fall further, leading to shock, that will be trouble. So many posts on the network said what coronary heart disease patients regardless of the first to get a nitroglycerin containing the point of view is extremely wrong. Because many patients with coronary heart disease chest pain may be myocardial infarction with low blood pressure, this time with nitroglycerin is adding fuel to the fire.

The above is saying what part of the population needs nitroglycerin.

When using nitroglycerin, it is best to take it sublingually, which I guess we all know, that is, put the tablet under the tongue and hold it, don't chew it, hold it and it will melt on its own, because the venous plexus under the tongue is very rich, it can enter the bloodstream quickly, and quickly exert the therapeutic effect, so the classic usage is sublingual.

Those with glaucoma should use nitroglycerin with caution as it may aggravate glaucoma.

The prerequisite for taking nitroglycerin correctly is first to clarify what kind of heart disease it is. Heart disease is in fact a very general concept, there is no clear direction, angina pectoris, myocardial infarction, coronary heart disease, heart failure is more familiar heart disease, but, such as myocarditis, aortic coarctation, myocardial hypertrophy, pericarditis and so on can also be attributed to heart disease category. Different diseases are treated differently and should not be generalized. Secondly, recognize if there is actually a problem with your heart. After all, not all chest tightness and panic attacks and precordial discomfort are caused by heart disease. This is what we often say in the clinic, that medication is secondary to correctly diagnosing the disease. The main common diseases that can present with symptoms such as chest tightness and panic, precordial discomfort, and chest pain and their management are:

1. Angina pectoris: clinically, it is mainly a recurring transient pain behind the sternum after tension, anxiety, climate change, and exertion, radiating to the left shoulder, which can be relieved on its own by removing the causative factors, resting, or sublingual nitroglycerin, etc.; treatment measures: resting, relaxing, and taking one tablet of nitroglycerin under the tongue, and then taking it again after 5 minutes for relief, and then taking it for a maximum of 3 times in a row, and if the pain is not relieved, other diseases should be taken into consideration.

2. Myocardial infarction: severe and persistent chest pain for more than 30 minutes, accompanied by chest tightness, palpitation, sense of dying, profuse sweating, etc., and sublingual nitroglycerin is not obvious or can not be relieved; it is necessary to emergency thrombolysis or PCI surgery 6-8 hours after the infarction, to restore the blood supply to the myocardium of the infarcted area as soon as possible, and at the same time to give analgesia and anxiety relief.

3. Aortic coarctation: It occurs more often in hypertensive patients, with severe chest pain after intense emotions and strenuous activities, accompanied by profuse sweating, which can lead to rapid death and requires urgent treatment. The main treatment principles are analgesia, emergency surgical or interventional procedures, relief of patient anxiety, and usual attention to blood pressure control.

4. Acute pericarditis: associated with viral infection, mainly manifested as pain in the precordial area and retrosternal area, which can be seen together with fever, and can be radiated to the neck and the left upper limb; the pain can be constrictive or sharp, and is aggravated by inhalation and coughing, and can be accompanied by dyspnea if the exudation is obvious; bed rest, antipyretic, anti-inflammatory and analgesic, etc., are needed.

5. Gastroesophageal reflux (GERD): it occurs mostly after a full meal, lying down or bending over after a meal, or in obese people, presenting burning pain behind the sternum, which may be accompanied by heartburn and acid reflux; the treatment is to inhibit the secretion of gastric acid by PPIs (**razoles).

6. Intercostal neuralgia: recurrent, episodic, transient, pinprick-like pain in the anterior and posterior chest and back that can be relieved on its own, with no fixed location; treatment is based on eliminating undesirable triggers.

In addition, herpes zoster, bile heart syndrome, spontaneous pneumothorax, lung cancer, and hysterical episodes can present with similar clinical manifestations and should be differentiated clinically.

If it is clear that nitroglycerin can be taken for a condition such as acute angina, the following points should be noted:

(1) A fast-acting sublingual dose of nitroglycerin is required for rapid onset of action;

(2) Generally take the sitting position, because nitroglycerin is a vasodilator, standing position is prone to postural hypotension, and the increase in the volume of returned blood in the prone position can aggravate the burden on the heart;

(3) Contain up to three doses of 1 tablet per episode, 5 minutes apart;

(4) Check whether the drug is within the shelf life or whether it is still effective. Nitroglycerin usually needs to be protected from light for storage, and the active ingredients will easily volatilize and decompose and become ineffective after prolonged exposure to sunlight or air.

(5) Patients with glaucoma, hypotension, intracranial hemorrhage, high intracranial pressure, application of cardiotonic agents, and hypertrophic obstructive cardiomyopathy require contraindication or caution.

Answerer: Zhang Kehui, M.S., M.A.
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Nitroglycerin tablets are commonly used by patients with coronary heart disease, and are also the most effective drugs for acute attacks of angina pectoris, but many patients do not have a comprehensive understanding of the drug, so that there are often some accidents due to the wrong taking of nitroglycerin, then, how should we correctly apply the drug?

First, the correct use of the drug should be sublingualization, when angina attack take 1 tablet of nitroglycerin under the tongue slowly contained, if the drug is exhausted and the symptoms have not yet been relieved, you can re-contained 1 tablet every 5 minutes until the pain is relieved, but need to pay attention to is that the dosage of nitroglycerin tablets should not be more than 3 tablets during each angina attack, if you take 3 tablets of pain can not be relieved, it is to be considered whether the If the pain is not relieved after taking 3 tablets in a row, then consider whether an acute myocardial infarction has occurred, and the best thing to do is to immediately call 120 emergency telephone for help;

Secondly, when taking nitroglycerin, in order to avoid fainting due to drug-induced hypotension, patients should keep themselves in a sitting or lying position;

Third, when angina attacks, patients with coronary artery spasm will lead to insufficient blood supply to the heart, and nitroglycerin diastolic peripheral vasculature will further reduce the amount of blood back to the heart, if this time the amount of activity is greater, it will increase the heart's oxygen consumption, and then aggravate myocardial ischemia, so, when taking nitroglycerin should minimize the activities;

Fourth, nitroglycerin tablets should be placed within the patient's reach so that the patient can take the medication quickly;

Fifth, nitroglycerin should be banned in early myocardial infarction with severe hypotension and tachycardia, severe anemia, glaucoma, increased intracranial pressure, and patients known to be allergic to nitroglycerin, and quick-acting heart-saving pills can be chosen as emergency medicine when necessary, but its effect varies from person to person!

The above is for reference only!