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Can you take too much nitroglycerin: The request could not be satisfied


Nitroglycerin overdose | Multimedia Encyclopedia | Health Information

Nitroglycerin is a medicine that helps relax the blood vessels leading to the heart. It is used to prevent and treat chest pain. Nitroglycerin overdose occurs when someone takes more than the normal or recommended amount of this medicine. This can be by accident or on purpose.

This is for information only and not for use in the treatment or management of an actual
. DO NOT use it to treat or manage an actual overdose. If you or someone you are with overdoses, call your local emergency number (such as 911), or your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.

Poisonous Ingredient


Where Found

Brand names of nitroglycerin tablets include:

  • Deponit
  • Minitran
  • Nitro-Bid
  • Nitrocine
  • Nitrodisc
  • Nitro-Dur
  • Nitrogard
  • Nitroglyn
  • Nitrol
  • Nitrolingual
  • Nitrong
  • Nitrostat
  • Transderm-Nitro
  • Tridil

Medicines with other names may also contain nitroglycerin.


Below are symptoms of a nitroglycerin overdose in different parts of the body.



  • Blurred vision
  • Double vision
  • Involuntary eye movements





  • Diarrhea
  • Cramping
  • Loss of appetite
  • Nausea and vomiting

Home Care

Seek medical help right away. Do NOT make a person throw up unless poison control or a health care provider tells you to.

Before Calling Emergency

Determine the following information:

  • Person’s age, weight, and condition
  • The name of the medicine and strength, if known
  • Time it was swallowed
  • The amount swallowed
  • If the medicine was prescribed for the person

Poison Control

local poison center
can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

What to Expect at the Emergency Room

Take the container with you to the hospital, if possible.

The provider will measure and monitor the person’s vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated. The person may receive:

  • Activated charcoal
  • Blood and urine tests
  • Breathing support, including oxygen and a tube through the mouth into the lungs
  • Chest x-ray
  • EKG (electrocardiogram, or heart tracing
  • Intravenous fluids (through a vein)
  • Laxative
  • Medicines to treat symptoms
  • Tube through the mouth into the stomach to empty the stomach (
    gastric lavage

Outlook (Prognosis)

Deaths from nitroglycerin overdose have occurred, but they are rare.


Cole JB, Roberts DJ. Cardiovascular drugs. In: Marx, JA, Hockberger RS, Walls RM, eds.
Rosen’s Emergency Medicine: Concepts and Clinical Practice
. 8th ed. Philadelphia, PA: Elsevier Saunders 2014:chap 152.

Hollander JE, Diercks DB. Acute coronary syndromes: acute myocardial infarction and unstable angina. In: Tintinalli JE, Stapczynski JS, Ma OJ, Cline DM, Cydulka RK, Meckler GD, eds.
Tintinalli’s Emergency Medicine: A Comprehensive Study Guide
. 7th ed. New York, NY: McGraw-Hill; 2011:chap 53.

Nitroglycerin. Drug Monograph, information provided by Gold Standard. Available at:
. Accessed August 19, 2015.

Richardson WH, Betten DP, Williams SR, Clark RF. Nitroprusside, ACE inhibitors, and other cardiovascular agents. In: Shannon MW, Borron SW, Burns MJ, eds.
Haddad and Winchester’s Clinical Management of Poisoning and Drug Overdose
. 4th ed. Philadelphia, PA: Elsevier Saunders; 2007:chap 61.

Nitroglycerin (Oral Route, Sublingual Route) Side Effects

Side Effects

Drug information provided by: IBM Micromedex

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common

  1. Bloating or swelling of the face, arms, hands, lower legs, or feet

  2. burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings

  3. difficult or labored breathing

  4. feeling faint, dizzy, or lightheadedness

  5. feeling of warmth or heat

  6. flushing or redness of the skin, especially on the face and neck

  7. headache

  8. rapid weight gain

  9. sweating

  10. tightness in the chest

  11. tingling of the hands or feet

  12. unusual weight gain or loss

  1. Bluish-colored lips, fingernails, or palms

  2. dark urine

  3. fever

  4. pale skin

  5. rapid heart rate

  6. sore throat

  7. unusual bleeding or bruising

  8. unusual tiredness or weakness
Incidence not known

  1. Arm, back, or jaw pain

  2. blurred vision

  3. chest pain or discomfort

  4. chest tightness or heaviness

  5. confusion

  6. cough

  7. cracks in the skin

  8. difficulty with swallowing

  9. dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

  10. fainting

  11. fast, irregular, pounding, or racing heartbeat or pulse

  12. feeling of constant movement of self or surroundings

  13. feeling of warmth

  14. hives, itching, or rash

  15. increased sweating

  16. loss of heat from the body

  17. nausea or vomiting

  18. puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

  19. red, swollen skin

  20. redness of the face, neck, arms, and occasionally, upper chest

  21. scaly skin

  22. sensation of spinning

  23. weakness

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

  1. Bluish-colored lips, fingernails, or palms

  2. blurred or loss of vision

  3. bulging soft spot on the head of an infant

  4. change in consciousness

  5. change in the ability to see colors, especially blue or yellow

  6. cold, clammy skin

  7. dark urine

  8. difficulty breathing

  9. disturbed color perception

  10. dizziness or lightheadedness

  11. double vision

  12. fever

  13. flushed skin

  14. halos around lights

  15. headache, severe and throbbing

  16. increased sweating

  17. loss of appetite

  18. loss of consciousness

  19. night blindness

  20. overbright appearance of lights

  21. pale skin

  22. paralysis

  23. slow or irregular heartbeat

  24. sore throat

  25. tunnel vision

  26. unusual bleeding or bruising

  27. unusual tiredness or weakness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

  1. Abdominal or stomach pain

  2. body aches or pain

  3. congestion

  4. hoarseness

  5. lack or loss of strength

  6. runny nose

  7. sneezing

  8. stuffy nose

  9. tender, swollen glands in the neck

  10. voice changes

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Portions of this document last updated: Feb. 01, 2021

Copyright © 2021 IBM Watson Health. All rights reserved. Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes.


Using Nitroglycerin for Angina | Michigan Medicine

Topic Overview

What is nitroglycerin?

Nitroglycerin is a vasodilator, a medicine that opens blood vessels to improve blood flow. It is used to treat angina symptoms, such as chest pain or pressure, that happens when there is not enough blood flowing to the heart. To improve blood flow to the heart, nitroglycerin opens up (dilates) the arteries in the heart (coronary arteries), which improves symptoms and reduces how hard the heart has to work.

Nitroglycerin comes in quick-acting forms and long-acting forms.

Quick-acting forms of nitroglycerin are used to relieve angina or used just before activities that typically cause angina. The quick-acting forms include tablets or oral sprays. The tablets are placed under the tongue (sublingual) or between the cheek and gum (buccal). The spray is used on or under the tongue. This topic covers these quick-acting forms of nitroglycerin.

Long-acting forms of nitroglycerin are used to prevent angina from happening. They are not used to stop sudden symptoms of angina. These long-acting forms include pills, tablets, skin ointment, and skin patches. This topic does not cover these long-acting forms of nitroglycerin.

Your doctor will prescribe the right amount for you. Do not use another person’s nitroglycerin.

When do I use quick-acting nitroglycerin?

Your doctor will advise you when to use your nitroglycerin. In general, quick-acting nitroglycerin is used:

  • To relieve sudden angina.
  • Before stressful activities that can cause angina, such as walking uphill or having sexual intercourse.

How do I use quick-acting nitroglycerin?

  • Sit or lie down to take your nitroglycerin. If you are driving, pull over and park the car. Taking nitroglycerin can lower your blood pressure, which could cause you to pass out if you are standing up.
  • For sudden episodes of angina, use nitroglycerin in a tablet or liquid spray form.
    • Place the under-the-tongue (sublingual) tablet under your tongue. Leave it there until it dissolves. If you accidentally swallow the tablet, take another. The medicine won’t work if it is swallowed.
    • Place the between-cheek-and-gum (buccal) tablet between your cheek and gum. Leave it there until it dissolves. If you accidentally swallow the tablet, take another. The medicine won’t work if it is swallowed.
    • Use the spray under your tongue or on top of your tongue. Push the spray canister button once. Close your mouth right away.
  • Take one tablet or spray dose. If after 5 minutes your angina symptoms are not better or get worse, call 911 or other emergency services immediately.
  • After you call 911, continue to stay on the phone with the emergency operator. He or she will give you further instructions.
  • Regardless of what happens, you should let your doctor know that you had an episode of angina. If this is unusual for you, if your angina episodes are occurring more frequently or lasting longer, or if you need more medicine to control them, tell your doctor.

Are there side effects or interactions with other drugs that I should be aware of?

Normal, temporary side effects of nitroglycerin include a warm or flushed feeling, headache, dizziness, or lightheadedness. You may also feel a burning sensation under your tongue.

Do not take an erection-enhancing medicine if you are taking nitroglycerin. These medicines include sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). Combining nitroglycerin with any of these medicines can cause a life-threatening drop in blood pressure. If you have angina and have taken one of these erection-enhancing medicines, be sure to tell your doctor so that you are not given nitroglycerin or another nitrate medicine.

Do not take the pulmonary hypertension medicine sildenafil (Revatio) if you are taking nitroglycerin or another nitrate medicine.

How should I store nitroglycerin?

Store nitroglycerin pills in a dark-colored (such as brown), airtight, glass container that you cannot see through. Keep the container tightly closed. Keep nitroglycerin pills and liquid spray away from heat or moisture.

Can nitroglycerin get old and lose potency?

Nitroglycerin can get old. And when it is old, it may not work. If your nitroglycerin supply is past its expiration date, get a new prescription as soon as possible. Keep your nitroglycerin in the container it came in and tightly closed. Do not open your sublingual nitroglycerin until you need a dose. Replace your tablets every 3 to 6 months. A nitroglycerin spray may last up to 2 years before it expires.

You may get a headache when you use nitroglycerin. Or you may feel burning or tingling under your tongue with nitroglycerin that is used under the tongue. But if you don’t have a headache or feel burning or tingling under your tongue, it does not mean the medicine is not working.

A cardiologist’s advice on how to use this “wonder drug” – Heart Sisters

by Carolyn Thomas  ♥ @HeartSisters

The heart drug called nitroglycerin was once described like this in the American Heart Association’s journal Circulation:

“Newer drugs quickly replace older remedies. This has not been the case with nitroglycerin, now in continuous medical use for more than a century.

“Although other applications for it have been found in cardiology, nitroglycerin is the mainstay for affording rapid, indeed almost immediate, pain relief for angina pectoris.

“At a time when the cost of pharmaceuticals is growing out of reach for many, nitroglycerin is still obtainable for pennies and remains one of the best buys in medicine. ”    

My little canister of nitro spray is indeed one of my closest companions. Since surviving a heart attack in 2008, and particularly since being further diagnosed with debilitating coronary microvascular disease, I would never even dream of setting foot out the door without taking my quick-acting nitro tucked into my little green pocket wallet with me.  Nitroglycerin (or nitroglycerine, glyceryl trinitrate, or GTN) comes in either short- or long-acting forms:  spray, pills, skin ointment or transdermal patch, and as the AHA journal reminds us, it’s still one of the least expensive – and most immediately effective – of all my cardiac meds.

In cardiologist Dr. Bernard Lown‘s comprehensive article about nitroglycerin, he explains: (1)

Angina pectoris is a discomfort behind the breastbone caused by a temporary inadequacy of blood flow to the heart muscle. It is not a heart attack. There is no heart damage. Many patients have had thousands of such episodes and live full and active lives reaching a ripe old age.

“Nitroglycerin is a wonder drug. When it is taken properly  – positive drug action is hastened by sitting, leaning forward, inhaling deeply, and bearing down as if for a bowel movement – it can help patients with angina achieve the goal of a pain-free life with little or no limitations.

“When you take nitroglycerin, your heart is able to do much more work without developing angina. It is common to see patients with angina return to full activity, largely because they have mastered the proper use of nitroglycerin.

“No matter how often you use it, it will consistently continue to work. It can help in the following circumstances:

  • Brisk walking
  • Cold, windy weather
  • Exertion
  • After a heavy meal
  • Working under the pressure of a deadline
  • Speaking in public
  • During sexual intercourse
  • During worry, tension or anger

“Nitroglycerin is truly a wonder drug. It dilates coronary arteries and decreases the workload of the heart, two factors responsible for the discomfort.

Yet many anginal patients use the drug only sparingly, if at all.

“Early in my medical practice some 60 years ago, I was dismayed to learn that a majority of my angina patients did not take nitroglycerin despite my careful counseling. They failed to use it preventively – or even with chest discomfort.

“In many conversations, I learned that patients had to overcome a number of psychological hurdles about taking nitroglycerin. These included:

  • an uncertainty about when exactly to take it
  • a hope that an episode would rapidly abate spontaneously
  • the fear of a throbbing headache (reported in over 2/3 of patients)
  • anxiety that if nitro worked, it was proof of a cardiac problem
  • an unwillingness to acknowledge having a heart condition that could cripple or kill
  • an unreadiness to become dependent on or habituated to drugs”

How to take your nitro:

As a heart patient with ongoing bouts of chest pain who’s had an up-close and personal relationship with my nitro spray, I understand each of these factors, including nitroglycerin’s dreaded Rule Of Three.   Here’s how it works if you’re using a nitro spray or tablets:

1. Sit or lie down to take your nitroglycerin (as directed in Dr. Lown’s instructions: sit down, lean forward, inhale deeply, and bear down as if for a bowel movement). If you are driving, pull over and park the car. Taking nitroglycerin can lower your blood pressure, which could cause you to pass out if you are standing up. Take the first dose of nitro when you start having serious chest pain, and wait five minute to see if the symptoms start to decrease.

2. If not, take a second dose (as above). Wait another five minutes.

3. If your pain persists, take a third dose – but you’d better be calling 911 at the same time. 

This advice means that anytime a heart patient suffering alarming cardiac symptoms decides to take even that first dose, it’s with the  knowledge that today just might be the day you have to go back to hospital to seek medical attention.

Dr. Lown was absolutely right! Over the past few years, in fact, I’ve spent countless hours foolishly suffering needlessly while trying to postpone that first nitro dose for just this reason: pure, unadulterated, frightened denial.

Yet as Dr. Lown advises, nitroglycerin is most helpful when taken at the first onset of chest discomfort – rather than after it has been present for several minutes.

For most patients living with regular angina symptoms, I have this advice based on Dr. Lown’s work:

“Nitro is your friend!”

Like many other angina patients I know, I’ve also had the experience of carefully weighing which kind of pain feels worse: my alarming chest pain, or nitro’s famous “nitro headache” side effect as it dilates the body’s blood vessels (including those in the head). 

That’s why I liked Dr. Lown’s story of the advice he used to give his own patients living with angina after he guessed why they were so reluctant to take nitroglycerin (he talks about nitro pills, but it’s equally true for nitro spray):

“Listening carefully to dribs and drabs of stories from patients, I imagined the reality. It led to a drastic change in how I prescribed nitroglycerin. I started telling them:

“This small pill dissolves almost instantly. When it does, you have a tingling sensation under the tongue. You may experience a nice fullness and a very nice throbbing sensation in the head. These are due to a rush of blood confirming that your heart, like your head, is receiving more sorely needed oxygen.

“As a dividend you also get more oxygen delivered to your brain; most of us can profit from a little clearer thinking!”

After I read that story last year, I decided to follow Dr. Lown’s sneaky advice.

With the very next spray of required nitro, I began slowly breathing mindfully, waiting for that “nice fullness and a very nice throbbing sensation” in my head as I visualized the nitro dilating my reluctant blood vessels, imagining that lovely “rush of sorely needed oxygen” being delivered to my needy heart muscle – and my brain.

It’s still a headache, don’t get me wrong. But now it’s a “nice” ache for a very good cause. Many patients find this side effect eases up over time.  I’ve also found that it helps to take a Tylenol 10-15 minutes before taking nitro. Note: The Food and Drug Administration sets the maximum acetaminophen (Tylenol) limit for adults at 4,000 milligrams per day. 

Before using a nitro spray for the first time, spray the pump into the air once or twice, away from yourself, others, or open flame. This is known as priming the pump. If you have not used this medication for six weeks or more, you’ll need to prime it again before use.

Do not shake the container!

Dr. Lown still likes to quotes his teacher and mentor Dr. Sam Levine, who maintained that the free use of nitroglycerin enables patients with angina to outlive their doctors.(2)

And he also reminds us:

Taken early, nitro protects the heart from possible injury. When chest discomfort is promptly relieved, there is no need to interrupt activities – except perhaps to slow their tempo. Better still is to take a pill in anticipation of discomfort. Under such circumstances of increased exertion, excitement, or anxiety, it may be worthwhile to take nitroglycerin preventively, thereby preventing angina’s very occurrence.”

Taking nitro in anticipation of chest discomfort is also what I heard about recently from another heart patient living with debilitating bouts of angina. She also happens to be an elite tennis player who plays almost daily. She has learned firsthand the benefits of preventive nitro therapy.  For example, before and again halfway through each tennis game, she sits down next to the court, takes a shot of nitro spray, waits five minutes and then starts playing. By doing this, she’s able to keep up her daily tennis games.

According to Dr. Lown, nitroglycerin is not habit-forming, as it is neither a narcotic nor a pain-killer. Nitro tablets or spray can be taken a number of times throughout any given day as needed (as I’ve experienced on particularly bad days) or by wearing a long-acting transdermal nitro patch.

If you’re using a nitro patch, by the way, you’ll likely be told to take a 10-12 hour “patch break” each day. This will help to reduce the risk of developing a tolerance to the drug (which could mean it won’t work as effectively to manage your angina symptoms). So you’ll be wearing a new patch each day, wearing it for 12-14 hours, discarding that patch and next morning starting again with a new patch. Read the product instructions carefully and always follow your physician’s specific guidance. And never, ever cut a patch in half.

While many heart patients now know and love nitro as an effective vasodilator to treat severe chest pain symptoms or heart failure, nitroglycerin has also been used since the 1860s as an active ingredient in the manufacture of explosives, most notably dynamite, patented in 1867 by the famous scientist, Alfred Nobel. (3)

British physician Dr. William Murrell began treating his heart patients with small diluted doses of nitroglycerin in 1878 to replace the previous angina treatment called amyl nitrite (which worked well, but carried truly dreadful side effects).  Angina relief with nitro was adopted into widespread use by physicians after Dr. Murrell published a study on it in the journal The Lancet in 1879.

Dr. Billy Goldberg is a New York emergency physician and the co-author (with Mark Leyner) of two fascinating books about health trivia. He explains that the medicinal dose of nitroglycerin in our heart medication is infinitesimal compared with the amount in a stick of dynamite. And it’s also highly diluted for safe handling.

Ironically, many years later, Alfred Nobel – the scientist who had first used nitro in the dynamite his company patented – was prescribed nitroglycerin for his own chronic angina pain.

A few months before his death in 1896, Nobel wrote to a friend:

“Isn’t it the irony of fate that I have been prescribed nitroglycerin to be taken internally? They call it Trinitrin, so as not to scare the chemist and the public.”

IMPORTANT: This post should not be interpreted as medical advice. See your own physician for more information about chronic angina or nitroglycerin. Nitro is not recommended for certain patients – find out if you’re among this group.

NOTE FROM CAROLYN:   I wrote more about the important topics of addressing angina pain in my new book, “A Woman’s Guide to Living with Heart Disease” (Johns Hopkins University, November 2017).  You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the code HTWN to save 20% off the list price).


(1) Dr. Bernard Lown, author of The Lost Art of Healing: Practicing Compassion in Medicine, is the co-founder of the medical organization called International Physicians for the Prevention of Nuclear War, which was awarded the 1985 Nobel Peace Prize. He’s also known as a pioneer in research on sudden cardiac death. Dr. Lown developed the direct current defibrillator for resuscitating the arrested heart, as well as the cardioverter for correcting disordered heart rhythms.  I’m a big fan of Dr. Lown’s work and his writing (see my previous articles about him here, here and here). But he’s first and foremost a cardiologist who’s been practicing medicine for over 60 years.

(2) Dr. Sam Levine is the same doctor who first observed that many patients suffering in mid-heart attack will hold a clenched right fist over the chest to describe their cardiac symptoms. This distinctively common reaction is now known by physicians as Levine’s Sign.

(3) Marsh N., Marsh A. “A Short History Of Nitroglycerine And Nitric Oxide In Pharmacology And Physiology.” Clinical and Experimental Pharmacology and Physiology. Volume 27, Issue 4. p313–319, April 2000.


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Nitrostat – Uses, Side Effects, Interactions

How does this medication work? What will it do for me?

Nitroglycerin belongs to the class of medications called antianginals. Nitroglycerin sublingual (under the tongue) tablets are used to relieve acute attacks of angina (chest pain). This medication can also be used to prevent an acute attack if taken in advance of an activity that would normally cause an angina attack. Nitroglycerin relieves and prevents acute angina attacks by relaxing blood vessels and increasing the oxygen and blood supply to the heart.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

0.3 mg
Each small, round, white sublingual tablet, marked with “N” on one side and the number “3” on the other side, contains nitroglycerin 0. 3 mg. Nonmedicinal ingredients: calcium stearate, glyceryl monostearate, lactose monohydrate, pregelatinized starch, and silicon dioxide. Gluten-, paraben-, sodium-, sulfite-, and tartrazine-free.

0.6 mg
Each small, round, white sublingual tablet, marked with “N” on one side and the number “6” on the other side, contains nitroglycerin 0.6 mg. Nonmedicinal ingredients: calcium stearate, glyceryl monostearate, lactose monohydrate, pregelatinized starch, and silicon dioxide. Gluten-, paraben-, sodium-, sulfite-, and tartrazine-free.

How should I use this medication?

To use nitroglycerin sublingual tablets, place a tablet under your tongue at the first sign of an angina attack. The dose may be repeated twice with at least a 5-minute interval between each dose, or as directed by your doctor. If relief is still not obtained after 3 doses of nitroglycerin (i.e., 15 minutes), seek medical help immediately.

While using nitroglycerin sublingual tablets you should be resting, preferably in a sitting position.

As directed by your doctor, the sublingual (under the tongue) tablet may be used 5 to 10 minutes before engaging in activities that may cause angina.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is very important to take this medication exactly as prescribed by your doctor.

Keep this medication away from moisture and out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take nitroglycerin sublingual tablets if you:

  • are allergic to nitroglycerin or any ingredients of the medication
  • are allergic to other nitrates
  • are experiencing a heart attack
  • have increased pressure within the head (e. g., after an accident)
  • have severe anemia (low red blood cells)

People who use nitroglycerin regularly or intermittently should not use erectile dysfunction medications called PDE-5 inhibitors (sildenafil, tadalafil, vardenafil) because a life-threatening lowering of blood pressure can result.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • fast heartbeat
  • flushing of the face and neck
  • headache
  • nausea
  • spinning sensation
  • vomiting
  • weakness

Although most of these side effects listed below don’t happen very often, they could lead to serious problems if you do not  seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • blurred vision
  • dizziness or lightheadedness, especially when getting up from a sitting or lying down position
  • fainting
  • headache (severe or prolonged)
  • paleness
  • sweating

Stop taking the medication and seek immediate medical attention if any of the following side effects occur:

  • signs of a serious allergic reaction (e. g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
  • signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort

Contact a doctor at once if any of the following signs of overdose occur:

  • bluish-coloured lips,fingernails, or palms of hands
  • convulsions (seizures)
  • dizziness (extreme) or fainting
  • feeling of extreme pressure in head
  • fever
  • shortness of breath
  • unusual tiredness or weakness
  • weak and fast heartbeat

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Dizziness: Nitroglycerin may cause dizziness or a spinning sensation (vertigo), affecting your ability to drive or operate machinery. Avoid these and other hazardous tasks until you have determined how this medication affects you.

Low blood pressure: Headaches or symptoms of low blood pressure such as weakness or dizziness, particularly when getting up from a sitting or lying down position, may result from taking too much nitroglycerin. If these symptoms occur, your doctor may reduce the dose or stop the use of nitroglycerin. People who might be negatively affected by low blood pressure should use nitroglycerin sublingual tablets with caution. People who take diuretics or have preexisting low blood pressure may be at a greater risk of experiencing low blood pressure.

Medical conditions: The benefits and safety of nitroglycerin sublingual tablets for people who have an acute heart attack or congestive heart failure have not been established.

Tolerance: Nitroglycerin users may develop tolerance to the medication, resulting in it not working as well. Tolerance to other nitrates or nitrites can also happen, especially if long-acting nitrates are used at the same time. As tolerance to nitroglycerin develops, the effect of fast-acting sublingual (under the tongue) nitroglycerin is somewhat reduced.

Pregnancy: This medication has not been studied for use by pregnant women and should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if nitroglycerin sublingual passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of this medication for children have not been established.

What other drugs could interact with this medication?

There may be an interaction between nitroglycerin and any of the following:

  • alcohol
  • aldesleukin
  • aliskiren
  • alpha blockers (e.g., alfuzosin, doxazosin, tamsulosin)
  • alpha agonists (e.g., clonidine, methyldopa)
  • angiotensin converting enzyme inhibitors (ACEIs; captopril, enalapril, ramipril)
  • angiotensin receptor blockers (ARBs; e.g., candasartan, irbesartan, losartan)
  • barbiturates (e.g., butalbital, pentobarbital phenobarbital)
  • beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
  • brimonidine
  • bromocriptine
  • calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
  • diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
  • duloxetine
  • ergot alkaloids (e.g., dihydroergotamine, ergonovine,  ergotamine, methylergonovine)
  • guanfacine
  • heparin
  • hydralazine
  • levodopa
  • minoxidil
  • nitrates (e. g., nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)
  • phosphodiesterase 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
  • prilocaine
  • quetiapine
  • riociguat
  • risperidone
  • rosiglitazone
  • tricyclic antidepressants (e.g., amitriptyline, nortriptyline)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Nitrostat

Nitroglycerin Poses Risks to the Heart—but There’s an Easy Fix

Though nitroglycerin has been used as a heart medication for over 100 years, scientists have only just recently started looking at it in the lab

In an ironic twist, researchers report that the classic heart-protecting medication nitroglycerin may actually cause heart attacks to be more severe if given over a prolonged period. But administering another medication with it may bring the risk back down to virtually nil, so that its protective effect alone can be experienced.

Nitroglycerin has long been given to people who are suffering angina (chest pain) and to heart attack patients to improve blood flow. The medication works by opening up blood vessels so that the heart can receive more oxygen-rich blood. But when given over a prolonged period of time, as it often is in hospitals, an effect called desensitization can occur, in which blood flow is actually reduced, making the heart attacks that do occur more severe.

Though nitroglycerin treatment is old, delving into its full effects in the laboratory is new. Study author Daria Mochly-Rosen says, “Here is a practice in medicine used for over 100 years. Nitroglycerin is so old that a proper clinical trial has never been formally done. Our study says it’s time for cardiologists to examine the value of nitroglycerin treatment that extends for hours at a time.

Mochly-Rosen and her team gave rats nitroglycerin for a period of 16 hours, and found that when they did have heart attacks, they were twice as severe as those who hadn’t had the medication. The damage to the heart muscle was worse, and heart function was considerably compromised. This finding is important since hospitals typically give nitroglycerin in cycles: 16 hours on the medication, and eight hours off. But the new findings suggest that even this length of cycle time may not be completely safe.

Luckily, the researchers also found an effective fix. Giving an enzyme activator Alda-1 seemed to reverse the damaging effects of nitroglycerin. One of the reasons that nitroglycerin can eventually be harmful to the heart is that it destroys an enzyme called ALDh3. This enzyme is responsible for converting nitroglycerin to nitric oxide, the compound that dilates blood vessels and increases blood flow. So by destroying the enzyme, nitroglycerin is dampening the very process in which it plays its helpful role.

Summing up her results, Mochly-Rosen said, “Basically it’s a cautionary tale … what we found is that if you use [nitroglycerin] for too long, the enzyme that helps protect against tissue damage — ALDh3 — dies. With our animal model, we demonstrated that the loss of this enzyme makes the outcome from the heart attack worse. Nitroglycerin is not benign.” On the other hand, said Mochly-Rosen, “if we had Alda-1 on board, we protected them.”

It’s strange that a practice that’s been around for so long can still present mysteries to researchers. But, as the study shows, learning more about these processes can lead to effective remedies. Hopefully clinicians will take this research into account in the future, as they administer treatments to people who have suffered chest pains or heart attack.

The research was published in the November 2, 2011, issue of Science Translational Medicine, and carried out at Stanford University.

Image: mysontuna/Shutterstock.

This article originally appeared on TheDoctorWillSeeYouNow. com, an Atlantic partner site.

Nitroglycerin overdose – Lifestyle News


Nitroglycerin is a medicine that helps relax the blood vessels leading to the heart. It is used to prevent and treat chest pain. Nitroglycerin overdose occurs when someone accidentally or intentionally takes more than the normal or recommended amount of this medication.

This is for information only and not for use in the treatment or management of an actual poison exposure. If you have an exposure, you should call your local emergency number (such as 911) or the National Poison Control Center at 1-800-222-1222.

Poisonous Ingredient


Where Found

Brand names of nitroglycerin tablets include:

  • Deponit
  • Minitran
  • Nitro-Bid
  • Nitrocine
  • Nitrodisc
  • Nitro-Dur
  • Nitrogard
  • Nitroglyn
  • Nitrol
  • Nitrolingual
  • Nitrong
  • Nitrostat
  • Transderm-Nitro
  • Tridil

Note: This list may not be all-inclusive.


Airways and lungs:

  • Shortness of breath
  • Slow breathing

Eyes, ears, nose, and throat:

  • Blurred vision
  • Double vision
  • Involuntary eye movements

Heart and blood vessels:

  • Heart palpitations
  • Low blood pressure
  • Rapid heartbeat or slow heartbeat

Nervous system:

  • Convulsions
  • Coma
  • Confusion
  • Dizziness
  • Fainting
  • Headache


  • Bluish color to lips and fingernails
  • Cold skin
  • Flushing

Stomach and intestines:

  • Diarrhea
  • Cramping
  • Loss of appetite
  • Nausea and vomiting

Home Care

Seek immediate medical help. Do NOT make a person throw up unless told to do so by Poison Control or a health care professional.

Before Calling Emergency

Determine the following information:

  • Patients age, weight, and condition
  • The name of the product (ingredients and strengths if known)
  • Time it was swallowed
  • The amount swallowed
  • If the prescription was prescribed for the person

Poison Control

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Take the container with you to the hospital, if possible.

See: Poison control center – emergency number

What to Expect at the Emergency Room

The health care provider will measure and monitor the patients vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. The patient may receive:

  • Activated charcoal
  • Blood and urine tests
  • Chest x-ray
  • EKG (electrocardiogram, or heart tracing
  • Breathing support
  • Intravenous (through the vein) fluids
  • Laxative
  • Tube through the mouth into the stomach to empty the stomach (gastric lavage)

Outlook (Prognosis)

Deaths have occurred, but are rare.


Keep all medications in child-proof bottles and out of the reach of children.


Hollander JE, Diercks DB. Intervention strategies for acute coronary syndromes. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 51.

Richardson WH, Betten DP, Williams SR, Clark RF. Nitroprusside, ACE inhibitors, and other cardiovascular agents. In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchesters Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 61.

Review Date:


Reviewed By:

Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

MUZ “City Hospital No. 1”

Lesson 3

“Provision of medical care for myocardial infarction, an alternative to drug treatment”

In such a serious condition as myocardial infarction, emergency hospitalization is required, when trying to provide assistance at home, you can lose too much time, in this regard, with an attack of angina pectoris that does not stop within 30 minutes, it is necessary to urgently call an ambulance.

Treatment of myocardial infarction must be carried out only in a hospital in the intensive care unit. Moreover, the sooner the patient is delivered there, the more effective the result of subsequent treatment will be – it is important to focus the attention of patients on this.

Patients with myocardial infarction are transported on a stretcher or on a gurney to the intensive care unit of the cardiology department or to specialized units or intensive care wards. With an uncomplicated course of the disease, the patient’s stay in the intensive care unit is 3 – 5 days.

Currently, the duration of treatment for a patient with uncomplicated myocardial infarction in a hospital is about three weeks, the duration of hospitalization is determined by the attending physician and depends on the course of the disease.

Treatment of myocardial infarction begins with pain management. The most effective drugs for quickly relieving an attack of angina pectoris are drugs belonging to the NITRATE group: tablets or in the form of aerosols.

NITROGLYCERINE is the international name of the drug.Different manufacturers release it under their own trade names, which are listed below.

How do nitroglycerin preparations work?

Nitrates dilate the arteries of the heart and improve the supply of oxygen to the heart. Also nitrates reduce the stress on the heart. In general, it helps to reduce the incidence and severity of chest pain.

What are the rules for taking nitroglycerin preparations?

Take your medicine as directed by your doctor.Do not stop taking nitroglycerin without first consulting your doctor.

Never take more nitroglycerin than prescribed by your doctor.

During treatment, carry the package with the medicine with you, maintain a constant supply of the medicine.

This medicine has been prescribed for you only. Never give it to other people, even if you think they have a similar condition.

What to do if you miss a drug intake?

Take the missed dose as soon as you remember.

If you missed one dose of the medicine, and it is already time for the next dose, continue taking the drug in the recommended dose.

Do not take a double or extra dose of this medicine.

What is necessary for the treatment to be effective and safe?

When standing up suddenly, you may feel dizziness, weakness, darkness in your eyes. To avoid this problem, try to get up slowly.If you still feel these symptoms, you must again take a horizontal position, then sit down slowly and, in the absence of these manifestations, slowly stand up.

Avoid drinking alcohol during treatment as it may aggravate dizziness.

Before any surgical intervention, including dental care, tell your doctor that you are taking nitroglycerin.

What problems can nitrates cause?

Along with their benefits, all medicines can cause unwanted (side) reactions.They usually disappear or diminish after your body gets used to the medication.

Consult a physician if any of the following side effects occur: throbbing headache, facial flushing, hot flashes, dizziness, heart problems, palpitations.

Any other sensations that bother you that, in your opinion, are related to taking this medicine, you can discuss with your doctor.

If chest pain cannot be relieved with nitroglycerin or other nitrates, narcotic analgesics are administered intravenously.The pain must be removed, because it can lead to cardiogenic shock from which the patient is very difficult to remove.

There are three ways to improve the state of coronary blood flow:

  • 1. Dissolve the blood clot formed in the artery. This is the most modern method of treatment and it is called thrombolysis. The earlier the drug is injected to dissolve the blood clot, the better the result. The maximum effect is achieved within the first hour after the onset of myocardial infarction.This hour is even called “golden”. When the thrombus dissolves after 6 hours, only about 5% of the affected heart muscle can be saved. Used drugs belonging to the group FIBRINOLITICS (alteplase, streptokinase, tenecteplase, urokinase).

    How does the drug work?

    • Dissolve the clot formed in the artery.

    What problems can fibrinolytics cause?

    • Along with their benefits, all medicines can cause unwanted (adverse) reactions.
    • Bleeding from injection sites (does not require premature discontinuation of therapy) is the most common complication when using the drug.
    • Cardiac arrhythmias
    • Any other concerns you feel that you think are related to taking this medicine, you can discuss with your doctor.
  • 2. Reduce the workload on the heart.Prescribed drugs that lower pressure, reduce the volume of circulating blood, slow down the heart rate and thereby reduce the need for oxygen in the heart muscle and prolong the life of starving cells in the heart attack zone.

    This group includes β-ADRENO BLOCKERS.

    This group has an active anti-angina, antiarrhythmic effect. High efficiency is achieved by regulating the needs of your heart and the capabilities of your coronary arteries, i.e.That is, it puts the work of your heart into a more economical mode.

    If you are prescribed this group of drugs, you must monitor your heart rate and blood pressure. They reduce the heart rate (it is desirable that at rest it was 55-60 beats per minute), dilate the blood vessels of the heart, lower blood pressure (should be less than 140/90 mm Hg).

    Remember that this group of drugs is used for a long time, you can not skip and stop taking the drug without the knowledge of the doctor, if you cancel, you need to gradually reduce the dose over several days.The use of β-blockers reduces mortality after MI during the first year by 25%.


    BISOPROLOL is the international name of the drug. Different manufacturers release it under their own trade names, which are listed below.
    Aritel, Bidop, Biprol, Bisokard, Bisoprolol hemifumarate, Bisoprolol fumarate, Concor, Concor Cor, Corbis, Coronal
    CARVEDILOL is the international name of the drug.Different manufacturers release it under their own trade names, which are listed below.
    Acridilol, Atram, Vedicardol, Dilatrend, Carvedigamma, Carvedilol, Carvedilol Obolenskoye, Carvetrend, Carvedil, Cardivas, Coriol, Talliton
    METOPROLOL is the international name of the drug. Different manufacturers release it under their own trade names, which are listed below.
    Betalok, Vasokardin, Vasokardin retard, Corvitol 100, Corvitol 50, Metoprolol, Metoprolol Acri, Metoprolol Ratiopharm, Metoprolol tartrate, Egilok, Egilok retard

    How does the drug work?

    • Bisoprolol, metoprolol, carvedilol reduce the intensity of the heart, its oxygen demand, lower blood pressure, and also restore the impaired function of the heart muscle.

    What to do if you miss a dose?

    • Take the missed dose of medication as soon as you remember.
    • If ​​you have missed one dose of the drug, and it is already time for the next dose, continue taking the same schedule.
    • Do not take a double or extra dose of this medicine.

    What is required for the treatment to be effective and safe?

    • If ​​you have diabetes mellitus, check your blood glucose concentration regularly.
    • Before any surgery, including dental care, tell your doctor that you are taking bisoprolol.
    • Follow your healthcare provider’s dietary advice.

    What problems can beta blockers cause?

    • Along with their benefits, all medicines can cause unwanted (adverse) reactions.
    • Consult a doctor if any of the following side effects occur: dizziness, increased fatigue, chilliness of the limbs, sleep disturbances, nightmares, shortness of breath, skin rash, dry eyes, sexual problems, urinary problems, chilliness or excessive sweating, the appearance or intensification of shortness of breath, the appearance or intensification of edema, nasal congestion, sleep disturbance.
    • Any other concerns you feel that you think are related to taking this medicine, you can discuss with your doctor.

    ANGIOTENSIN INHIBITORS – A CONVERSING ENZYME (captopril, enalapril, lisinopril, fosinopril, perindopril, etc.) also protect the heart and blood vessels from pathological changes leading to the development of heart failure.

    ENALAPRIL is the international name of the drug.Different manufacturers release it under their own trade names, which are listed below.
    Bagopril, Berlipril 5, Berlipril 10, Berlipril 20, Vasopren, Vero-Enalapril, Invoril, Renipril, Renitek, Ednit, Enalapril, Enalapril-ICN, Enalapril-Acri, Enalapril Hexal, Enalapril-Rosla Enalapril maleate, Enam, Enan NM, Enap, Enarenal, Enapharm, Envas
    LISINOPRIL is the international name of the drug. Different manufacturers release it under their own trade names, which are listed below.
    Diroton, Irumed, Lizacard, Lizigamma, Lisinopril, Lisinopril Stada, Lisinopril dihydrate, Lisinoton, Lizoril, Listril, Litan, Sinopril
    PERINDOPRIL is the international name of the drug. Different manufacturers release it under their own trade names, which are listed below.
    Hypernik, Coverex, Perindopril, Perindopril erbumin, Perinpress, Prenessa, Prestarium

    How does the drug work?

    • Angiotensin-converting enzyme inhibitors dilate blood vessels, lower blood pressure, and increase the efficiency of the heart.
    • Along with their benefits, all medicines can cause unwanted (adverse) reactions.
    • Consult a doctor if any of the following side effects occur: cough, dizziness, headache, insomnia or drowsiness, severe weakness, skin rash, itching, fever, facial flushing, cough, nasal congestion, sore throat, pain in the abdomen, loose stools, constipation, palpitations, unusual taste in the mouth.

    It is necessary to draw the attention of patients that the most common side effect of ACE inhibitors is cough – it occurs in up to 20% of cases in women:

    • Important! Seek medical attention immediately if you experience sudden swelling of your tongue, lips or eyelids.
    • Any other concerns you feel that you think are related to taking this medicine, you can discuss with your doctor.
  • 3.To improve the rheological properties of blood – to reduce the ability of blood to form clots (anticoagulants, antiplatelet agents).

    You will be prescribed DIRECT ACTION ANTICOAGULANTS in the form of injections (sodium heparin, sodium enoxaparin, sodium dolteparin, calcium nadroparin).

    HEPARIN SODIUM is the international name of the drug. Different manufacturers release it under their own trade names, which are listed below.
    Heparin, Heparin “Biochemi”, Heparin BS, Heparin Lechiva, Heparin sodium, Heparin – Richter, Heparin – Ferein


    DALTEPARIN SODIUM is the international name of the medicine.

    NADROPARIN CALCIUM is the international name of the medicine.

    How does the drug work?

    • Direct anticoagulants reduce the ability of the blood to form blood clots (thrombi).

    Rules for the introduction of the solution.

    • The solution is injected subcutaneously into the anterolateral region of the abdominal wall at the waist level.
    • The patient must lie down during the injection.
    • When injected, the needle is inserted vertically to its full length into the thickness of the skin, clamped in the fold.
    • The skin fold is not straightened until the end of the injection.
    • Do not rub the injection site after injection.

    What problems can the drug cause?

    • Along with their benefits, all medicines can cause unwanted (adverse) reactions.
    • After SC injection, pain at the injection site, bruising (hematoma) at the injection site may occur. In some cases, the formation of solid inflammatory seals (infiltrates) containing the drug is possible, which dissolve after a few days, without the need to discontinue the drug.
    • Possible bleeding from mucous membranes and wounds
    • Important! Seek medical attention immediately if you have the following symptoms: rhinitis, urticaria, lacrimation, fever, bronchospasm.
    • Any other concerns you feel that you think are related to taking this medicine, you can discuss with your doctor.

    To prevent the formation of blood clots in the blood vessels of the heart, you need to constantly take medications that reduce blood clotting – ANTI-AGGREGANTS , usually acetylsalicylic acid 125 mg / day and clopidogrel 75 mg / day.

    ACETYL SALICYLIC ACID is the international name of the drug. Different manufacturers release it under their own trade names, which are listed below.
    ASK-cardio, Ascopirin, Aspivatrin, Aspikor, Aspinat, Aspinat 300, Aspinat Alco, Aspinat Cardio, Aspirin 1000, Aspitrin, Asprovit, Acecardol, Acetylsalicylic acid, Acetylsalicylic acid, Acetylsalicylic acid Ros, Acetylsalicylic acid-UBF, Atsbirin, CardiASK, Cardiopyrin, Nextrim Fast, Taspir, Therapin, Thrombo ACC, Upsarin Upsa, Fluspirin

    How does the drug work?

    • Acetylsalicylic acid reduces the severity of inflammation, pain and lowers body temperature.In addition, acetylsalicylic acid reduces the formation of blood clots (thrombi).

    What to do if you miss a dose?

    • Take the missed dose of medication as soon as you remember.
    • If ​​you have missed one dose of the drug, and it is already time for the next dose, continue taking the same schedule.
    • Do not take a double or extra dose of this medicine.

    What is required for treatment to be effective and safe?

    • Take your medicine at the same time of day.
    • If ​​you need to take acetylsalicylic acid with other medicines, ask your doctor about the safety of this combination.
    • Try to avoid bumps, cuts or any other damage, as acetylsalicylic acid reduces blood clotting.

    What problems can acetylsalicylic acid cause?

    • Along with their benefits, all medicines can cause unwanted (adverse) reactions.
    • Consult your doctor if any of the following side effects occur: abdominal pain, heartburn, nausea.
    • Important! Seek medical attention immediately if you experience any of the following symptoms: swelling of the face, mouth, neck, skin rash; shortness of breath or choking; black or bloody stools and red urine; deafness.
    • Any other concerns you feel that you think are related to taking this medicine, you can discuss with your doctor.
    KLOPIDOGREL is the international name of the medicine. Different manufacturers release it under their own trade names, which are listed below.
    Zylt, Clopidogrel hydrogen sulfate, Plavix

    How does the drug work?

    • Clopidogrel inhibits the ability of platelets (platelets) to bind to each other, which prevents blood clots (blood clots) from forming in blood vessels.

    What to do if you miss a dose?

    • Take the missed dose of medication as soon as you remember.
    • If ​​you missed one dose of the drug, and it is already time for the next dose, continue taking the drug in the recommended dose.
    • Do not take a double or extra dose of this medicine.

    What is required for the treatment to be effective and safe?

    • Before taking any over-the-counter medicine, talk to your doctor about how safe it is to combine with clopidogrel.
    • Do not take aspirin and other medicines containing acetylsalicylic acid unless prescribed by your doctor.
    • Clopidogrel may cause dizziness.

    What problems can clopidogrel cause?

    • Along with their benefits, all medicines can cause unwanted (adverse) reactions.
    • Talk to your doctor if any of the following side effects occur: abdominal discomfort or pain, fatigue, loose stools, constipation, headache, dizziness, poor motor coordination, tingling sensations in the limbs, skin rash, or itching.
    • Important! Seek medical attention immediately if bruising, bleeding, blood in the urine, or blackening of stool appear for no apparent reason.
    • Any other concerns you feel that you think are related to taking this medicine, you can discuss with your doctor.

    Medicines that lower the concentration of cholesterol in the blood – STATINS are very important. They reduce the size of existing atherosclerotic plaques and prevent the formation of new ones.The risk of death with continuous use of statins is reduced by 30-40%.


    International name of the drug. Various manufacturers release it under their own trade names.

    How do the drugs work?

    Reduce the formation of cholesterol in the liver, which further leads to a decrease in blood cholesterol.

    What to do if you miss a dose?

    • Take the missed dose of medication as soon as you remember.
    • If ​​you missed one dose of the drug, and it is already time for the next dose, continue taking the drug in the recommended dose.
    • Do not take a double or extra dose of this medicine.

    What is required for the treatment to be effective and safe?

    • Avoid drinking alcohol as it may reduce the effectiveness of treatment.
    • Remember that smoking has a negative effect on your body and reduces the positive effect of the drug.
    • Do not take the medicine with grapefruit juice, as this may increase the level of atorvastatin in the blood.
    • During treatment with the drug and at least one month after stopping it, women should use effective methods of contraception.
    • Before any surgery, including dental care, tell your doctor that you are taking the drug.

    What problems can statins cause?

    • Along with their benefits, all medicines can cause unwanted (adverse) reactions.
    • Consult a doctor if any of the following side effects occur: headache, abdominal pain, bloating, diarrhea or constipation, sleep disturbance, loss of appetite, tingling or numbness in the limbs, dizziness, skin rash, sexual problems, chest pain cage.
    • Important! Seek medical attention immediately if: severe weakness, muscle pain, yellowing of the skin.
    • Any other concerns you feel that you think are related to taking this medicine, you can discuss with your doctor.

    The above drugs are used, as a rule, for a long time, therefore they require medical supervision and an individual approach.Do not forget that if you feel better, in no case should you stop taking medications or reduce their dose yourself.

Treatment of angina pectoris (IHD) without surgery in Krasnoyarsk

If you have been diagnosed with coronary heart disease , angina , your doctor will definitely prescribe treatment for you – drug therapy, which he recommends to take continuously, without interruption.Why do you need to take medication regularly? And what drugs are used to treat angina pectoris, in what doses?

First and foremost in the presence of angina pectoris: prevent the complications of the disease ( myocardial infarction , life-threatening heart rhythm disturbances, the development of severe heart failure) and death, prolong your life. Second and no less significant: improve the quality of your life, make it complete, eliminate pain. There are several main groups of drugs for the treatment of angina pectoris .Let’s see how they work and why doctors prescribe them for treatment.

Treatment of angina pectoris: drugs and doses

Treatment of angina pectoris involves taking drugs such as antiplatelet agents, statins, beta-blockers, calcium antagonists, inhibitors, nitrates, cytoprotectors. Doses are prescribed by your doctor.

Antiplatelet agents

Antiplatelet agents help prevent blood clots
(blood clots), reduce the aggregation (sticking together) of platelets – blood cells,
which are responsible for the formation of a blood clot.The list of antiplatelet agents includes:
aspirin, cardiomagnyl, thienopyridines.

Aspirin (acetylsalicylic acid)

Aspirin (acetylsalicylic acid) – the main antiplatelet, it is prescribed to all patients suffering from angina “). The dose of aspirin is 75-150 mg daily. It is taken once, after 20-30 minutes. after meal. Usually in the afternoon.Pay attention to the low dose! In a regular 500 mg aspirin tablet, this dose has been taken as an analgesic and antipyretic agent for over 100 years! For angina pectoris, no more than 1/4 of the tablet is recommended. This dose effectively prevents thrombosis and is safe enough for the stomach. If you regularly take higher doses of aspirin (acetylsalicylic acid), there is a chance of developing erosions and stomach ulcers. Since patients with angina pectoris require constant intake of aspirin as a treatment, special, safer forms for long-term use have been developed.

Cardiomagnet (aspirin + magnesium hydroxide) Cardiomagnyl (aspirin + magnesium hydroxide) 75 and 150 mg. Magnesium hydroxide, which is part of the tablet, stimulates the formation of special protective substances in the wall of the stomach of a patient with angina pectoris, which prevent the formation of ulcers and erosions.

Aspirin in enteric coating (AspirinCardio 100 mg, ThromboAss 50 and 100 mg, CardiASK 50 mg, etc.) . A special coating does not allow the tablet to dissolve in the stomach, aspirin is absorbed in the intestine.Important: such tablets must be taken whole, they must not be broken or chewed (otherwise you will damage the shell and the protective effect will disappear)!

Thienopyridines (clopidogrel, prasugrel, ticlopidine)

Thienopyridines (clopidogrel, prasugrel, ticlopidine) – have a very pronounced antiplatelet effect, hundreds of times more powerful than aspirin. Prescription of these drugs (usually in conjunction with aspirin) is necessary in cases where the risk of thrombosis is very high: unstable angina , acute coronary syndrome (“preinfarction conditions”), acute myocardial infarction and cardiac surgery ( stenting , coronary artery bypass grafting , etc.etc.). Thienopyridines are also prescribed as a treatment for those patients who cannot take aspirin due to intolerance or contraindications.

Important: Tell your doctor if you have previously had a stomach ulcer, duodenal ulcer (duodenal ulcer) or erosive gastritis, as well as unstable blood pressure with frequent crises, rises above 160-170 / 100 mm Hg. Art. This information will help your doctor make your antiplatelet treatment safe. It has been proven that regular intake of antiplatelet agents can reduce the frequency of myocardial infarctions, strokes and death of patients with angina pectoris by up to 23% (in every 23 people out of 100)! After coronary angioplasty and stenting operations, doctors recommend taking aspirin and clopidogrel together for a certain period (from a month to several years).


Statins – antiatherosclerotic drugs , reduce the level of “bad” blood cholesterol (total cholesterol, LDL, triglycerides), increase the level of “good” cholesterol (HDL). With prolonged use of the drug in a dose that allows you to control cholesterol at the target level, they are able to stop the growth of atherosclerotic plaques and even reduce their size. Target cholesterol levels depend on the prevalence of atherosclerosis in the body and associated diseases (eg, diabetes mellitus).Ask your doctor what target levels you should have and at least 4 times a year monitor the effectiveness of treatment (blood tests for cholesterol and lipids). There is no addiction to statins and the development of dependence, treatment with statins should be carried out constantly. If you stop taking the drug on your own, then within one month after stopping the drug, the blood lipid level returns to the initial one.

Statins are able to reduce the risk of developing myocardial infarction and stroke by up to 30-40% (in every 30-40 people out of 100), and this effect is more pronounced in diabetics! The fact that statins save lives became known after several large studies were carried out, in which thousands and tens of thousands of patients with angina pectoris , diabetes mellitus, peripheral atherosclerosis participated.Today statins are recommended for the treatment of not only patients with angina pectoris , but also people without coronary artery disease, with several risk factors, for the prevention of atherosclerosis, heart attack and stroke.

Four drugs of this group are registered in Russia: simvastatin (Zokor), rosuvastatin (Krestor), atorvastatin (Liprimar) and fluvastatin (Lescol).

How to take statins

Take statins in the evening (before bedtime). There are drugs that can be taken at any time of the day.Possible nausea, stool disturbances. Do not recommend the appointment of statins to persons with active liver disease, during pregnancy and lactation. A very rare undesirable effect is muscle pain. If you start taking the drug and notice soreness in all the muscles of the body, be sure to tell your doctor to avoid unwanted complications. If you do not tolerate statins well or if the maximum therapeutic dose does not allow you to achieve control of lipid levels, then it is possible to reduce the dose and add an inhibitor of cholesterol absorption – ezetimibe.Also, your doctor may recommend the use of other lipid-lowering drugs for treatment: fibrates, sustained-release nicotinic acid.


Beta-blockers – reduce the heart rate (pulse), due to this, the work performed by the heart and the need for the heart muscle (myocardium) for oxygen is reduced, the blood supply to the heart is improved, the number of attacks is reduced angina pectoris and exercise tolerance increases.Beta blockers prevent and treat heart rhythm disturbances (arrhythmias). This is especially important after myocardial infarction suffered , when the arrhythmia often becomes life-threatening. Regular intake of beta-blockers can prevent the death of patients who have had a heart attack, up to 40% (in every 40 people out of 100!). Therefore, they are recommended to be prescribed to all patients after a heart attack , in the absence of contraindications. Beta blockers help normalize blood pressure. In most patients angina pectoris is combined with arterial hypertension , in this case taking a beta-blocker “kills two birds with one stone” – we treat hypertension and angina pectoris at the same time.Some beta blockers have been shown to prevent the development of heart failure. These include metaprolol succinate (BetalocZOK), bisoprolol (Concor), nebivalol (Nebilet), carvedilol (Dilatrend). This effect, as well as all of the above, is possible only with regular long-term use of the drug.

How to take beta blockers

Take a beta blocker daily, in the morning (sustained release, about 24 hours) or twice a day (morning and evening).The dose of the beta-blocker is selected individually. The dose is considered to be effective if your heart rate is 50-60 beats per minute while taking the drug alone. In this case, all the medicinal effects of the drug are manifested. You should not abruptly stop taking a beta-blocker – in the first days, reflexively, your heart rate may sharply increase and your health will worsen. In those 90,479 patients with angina pectoris who are taking a beta blocker to maintain the correct rhythm and prevent arrhythmias, interruptions in the work of the heart may resume after withdrawal.The undesirable effects of beta-blockers are characteristic mainly for non-cardioselective drugs (for example, a decrease in potency), and in modern highly cardioselective drugs, they are rarely manifested, as a rule, with an increase in dose. It is undesirable to prescribe beta-blockers to patients with bronchial asthma and chronic obstructive pulmonary disease (COPD), atherosclerotic lesions of the arteries of the lower extremities (obliterating atherosclerosis).

Calcium anagonists

Calcium anagonists – are able to dilate the blood vessels of the heart, increasing the flow of blood to the heart muscle (myocardium), thereby reducing the number of attacks of angina pectoris .They are divided into three main groups with characteristic features. Drugs from the group dihydropyridine calcium antagonists (nifedipine) can be prescribed together with beta-blockers, or instead of beta-blockers (in case of intolerance or contraindications to the latter). The first generations (nifedipine) increase the heart rate, therefore, short-acting tablets (nifedipine 10 mg) should not be taken for angina pectoris. There are special prolonged forms (osmo-adalat, corinfar-retard, nifecard) containing from 20 to 60 mg of nifedipine.The third generation of drugs (amlodipine, felodipine) practically does not increase the heart rate and is taken once a day. Drugs from the verapamil and diltiazem group reduce the heart rate; co-administration with beta-blockers is contraindicated due to the risk of bradycardia and other complications. It has been shown that regular intake of calcium antagonists can reduce the incidence of strokes.

If-channel inhibitors (coraxan)

If-channel inhibitors, currently the only representative is ivabradine (coraxan) .The drug is able to reduce the heart rate (pulse), thereby reducing the number of attacks of angina pectoris . Unlike beta-blockers, this inhibitor is effective only in sinus rhythm, does not affect cardiac arrhythmias and blood pressure, and is a symptomatic drug (eliminates the symptoms of the disease). The effect on the prognosis has not yet been proven (studies are underway). An inhibitor can be prescribed instead of beta-blockers (in case of intolerance or contraindications to the latter) or together with beta-blockers to achieve the target heart rate (50-60 beats per minute).

How to take Coraxan

Coraxan is taken at 2.5-5-7.5 mg 2 times a day (morning and evening). The appointment of ivabradine is not recommended if: heart rate at rest is below 60 beats / min (before starting treatment), severe arterial hypotension (SBP – below 90 mm Hg and DBP – below 50 mm Hg), severe hepatic failure, diagnosed with sick sinus syndrome, sinoatrial block or AV block of the III degree, permanent form of atrial fibrillation, chronic heart failure III-IV stage according to NYHA classification (there is not enough clinical data), an artificial pacemaker was implanted.

Angiotensin converting enzyme (ACE) inhibitors

Angiotensin converting enzyme (ACE) inhibitors for angina pectoris are prescribed to prevent the development of heart failure. Therefore, the doses of drugs are usually lower than in the treatment of hypertension. If, after suffering an MI, you develop symptoms of heart failure or doctors have identified impaired LV function, the addition of an ACE inhibitor to therapy will significantly reduce the risk of death and the likelihood of recurrent MI.The effect of drugs such as ramipril, trandolapril, zofenopril, enalapril has been proven. If these drugs are poorly tolerated, it is possible to replace them with angiotensin receptor antagonists. ACE inhibitors can be prescribed for angina pectoris and without a history of heart attack – their ability to slow the progression of atherosclerosis has been proven. The effect of the drugs ramipril and perindopril has been proven.


Nitrates have been used to relieve anginal pain with angina pectoris for more than 100 years! They are symptomatic (pain relieving) drugs that do not affect mortality and life expectancy.The effect of nitrates is the short-term expansion of blood vessels supplying the heart. There are many forms of nitrate release for different situations. For example – short-acting nitrates, nitroglycerin in the form of sublingual tablets (under the tongue), spray (Isoket, Nitromint, etc.) for quick relief of an angina attack. They relieve pain instantly, last 10-15 minutes. They are used not only to stop an attack that has already occurred, but also to prevent it (for example, before starting physical activity or in other situations in which, in your opinion, angina attack may develop).They are able to sharply reduce blood pressure for a short time.

How to use short-acting nitroglycerin:

  • Sit or lie down.
  • Take nitroglycerin (put a tablet under your tongue or spray under your tongue).
  • You can take 1-3 doses of nitroglycerin, there must be a break of about 5 minutes between doses.
  • Tell others that you are having a seizure and that you are not feeling well.
  • If ​​pain persists after 15 minutes, call an ambulance.

Nitrates of moderate duration (nitrosorbitol, isosorbide mononitrate and dinitrate 20 and 40 mg, etc.) act for several hours (up to 6 hours) and are used to prevent attacks of angina pectoris . Typically, these forms of nitrates are prescribed 2-3 times a day. Remember – if nitrates enter your body continuously, then after a few days the sensitivity of your vessels to nitroglycerin will decrease significantly and the drug will no longer prevent angina attacks .Therefore, when treating with nitrates of medium duration of action, “nitrate-free intervals” of up to 6-8 hours are required. Your doctor will prescribe you to take the drug for the morning and afternoon (until 5 pm), or for the day and evening, etc. Long-acting nitrates (retard forms of nitrates, 50 mg) will help to avoid the development of tolerance to nitrates. Such drugs are taken once a day, the action lasts up to 10 hours, providing the necessary intervals to restore vascular sensitivity.

Remember: Long-acting nitrates cannot be the main treatment! It is recommended to prescribe nitrates only if you are taking the main groups of drugs in an effective dose, but you still have attacks of angina pectoris .Short-acting nitrates – used on demand. Reception of nitrates is relatively often associated with the appearance of side effects (primarily headaches), the development of addiction (tolerance) to the drug when taken regularly, the possibility of a rebound syndrome in case of a sharp cessation of the drug intake into the body.


Cytoprotectants – protect against cardiac muscle cell death during episodes of acute and chronic lack of oxygen (ischemia), allowing cells to generate energy for heart contraction using less oxygen.The evidence base is available for the drug trimetazidine (Preductal MV). The drug has no contraindications (except for individual intolerance) and side effects.

The partnership between doctor and patient is the key to successful treatment of angina pectoris. Still have questions? Make an appointment!

Using materials from the article by N.S. Veselkova

Angina pectoris

Olga Beklemishcheva: Today, as announced, we will talk about angina pectoris.Why was it announced? Because the listeners asked us about it. And if someone thinks that this is wrong, then you can call me and advise. I’ll be very grateful.

Our guest is Nadir Migdatovich Akhmedzhanov, cardiologist, head of the laboratory for the prevention of cardiovascular complications in diabetes mellitus of the State Center for Preventive Medicine. The name is quite long, but the essence is very simple. Here we had a large, chic Cardio Center, which was naturally divided into many institutes, in particular, one of them is the Center for Preventive Medicine, which, I think, is engaged in a very useful business – it studies the possibilities of preventing heart disease and teaches us the right way treat your own health, which is what our program does.

And we move on to our topic. So, what is angina in general terms, Nadir Migdatovich?

Nadir Akhmedzhanov: Indeed, we often hear the word “angina”. And what is it really? In fact, angina pectoris is understood as a lack of blood delivery to the heart, to certain parts of the heart, which is clinically manifested by a feeling of heaviness, compression in the chest, as a rule, during physical exertion or during emotional stress.This is an attack of angina pectoris.

Olga Beklemishcheva: Here are angina pectoris and coronary heart disease, how do they relate to each other? In fact, it is believed that angina pectoris is a symptom of coronary heart disease.

Nadir Akhmedzhanov: This is one of the forms of coronary heart disease. The concept of “coronary heart disease” includes: angina pectoris, myocardial infarction …

Olga Beklemishcheva: … acute coronary syndrome.

Nadir Akhmedzhanov: Yes. Here the concept of “acute coronary syndrome” includes myocardial infarction and unstable angina pectoris. And one more form – what we call “atherosclerotic cardiosclerosis”, and abroad – “ischemic cardiomyopathy”. That is, “coronary heart disease” is a broader concept, and angina pectoris is one of the forms of coronary heart disease.

Olga Beklemishcheva: And as far as I understand, the most common?

Nadir Akhmedzhanov: Yes, that’s right.

Olga Beklemishcheva: In general, how many approximately people in the population suffer from angina pectoris? And are there any signs by age, gender, type of character?

Nadir Akhmedzhanov: As a rule, men suffer from angina pectoris more often, let’s say, after 40 years. If we take the characterological type … they used to say that it was so accepted: type “A”, type “B”. Type “A” – these are purposeful people, strong-willed, set themselves big tasks, that is, people who want to achieve a lot.These are the people, unfortunately, they are more likely to suffer from angina pectoris.

And besides, of course, hereditary predisposition matters. If there were cases of coronary heart disease and angina pectoris in the family, then there are more chances of developing angina pectoris. Although it is not absolutely a fact that even if parents, grandparents were sick, then their descendant will definitely be sick – this is not a fact. But the chances are, unfortunately, increasing.

And there are risk factors that, again, increase the odds. What are these risk factors?

Olga Beklemishcheva: Well, smoking, of course.

Nadir Akhmedzhanov: Yes, smoking. By the way, of the modified risk factors that we can eliminate, smoking is the most powerful risk factor for the development of coronary heart disease, including angina pectoris. Although, perhaps, smoking is even more important for acute situations – these are myocardial infarctions.

So, smoking, high cholesterol, diabetes, high blood pressure, age – the older a person is, the more likely it is to get sick, and many other factors.By the way, women before menopause have a significantly lower risk of developing coronary heart disease, angina pectoris, but after menopause …

Olga Beklemishcheva: But women, here they are so fragile … and often complain of heart pain just relatively young ladies. And what about them?

Nadir Akhmedzhanov: This problem exists all over the world. Indeed, young women very often complain of heart pain.They say: “The heart hurts” – but, as a rule, it is not angina pectoris. Angina pectoris is often not described as “pain in the heart”, namely as “a feeling of pressure, heaviness.” Even sometimes people cannot describe, they say: “How the stake got in the chest.” They cannot even clearly describe what it is. But when they say “pain in the heart”, and especially young women, then this, as a rule, is not angina pectoris, fortunately, and this is more often cardialgia, that is, pain in the heart that is not associated with vasoconstriction and a lack of blood supply due to this vessel.

Olga Beklemishcheva: Nadir Migdatovich, as it is now believed, the cause of angina is always vascular stenosis, is it always atherosclerosis? Or are there different etiologies?

Nadir Akhmedzhanov: Still, in the vast majority of cases, the pathomorphological substrate of angina pectoris is an atherosclerotic plaque, that is, stenosis (narrowing) of the coronary vessel. As a rule, angina attacks appear when the narrowing of the vessel reaches 50 percent – then attacks appear during physical exertion.And as the plaque grows and the vessel lumen narrows, then they can appear at lower load levels. So angina attacks in 90-95 percent of cases are caused precisely by atherosclerotic plaque. And in very rare cases, there is no plaque that narrows the lumen of the vessel, and the spasm of the vessel is responsible for the clinical picture – the so-called vasospastic angina, Prinzmetal’s angina. And there, indeed, if angiography is done, there are no visible narrowing of the coronary vessels. And angina attacks, as a rule, occur at night, in the early morning hours – at 3-4 hours.But this very rarely happens – here are 5-10 percent …

Olga Beklemishcheva: … of the entire population of patients.

Nadir Akhmedzhanov: From cases of angina pectoris. That is, it rarely happens. Even less often, maybe.

Olga Beklemishcheva: Then let’s “decompose” angina pectoris for clarity into groups and describe how they differ. As far as I understand, there is angina pectoris for the first time, then chronic, stable angina pectoris, unstable angina pectoris.Is that how they all differ from each other? And how are they located “on the way” to a heart attack? That is, what is there to be more afraid of?

Nadir Akhmedzhanov: Yes, this is very important, because when we know what is happening in our body, in the house, then it is easier, in general, to deal with it. So, when, unfortunately, seizures appear, then the risk of complications … when seizures first appear, then the risk of complications – a heart attack – increases. Therefore, this is the situation when attacks of angina pectoris first appear, and especially – which significantly reduce the level of physical activity, then… newly emerged angina pectoris, which significantly reduces the level of physical activity, it is dangerous just by the development of myocardial infarction. Therefore, in such cases, you should immediately consult a doctor.

Olga Beklemishcheva: And what does it mean – “significantly decreased”? That is, a person walked, felt this unpleasant state behind the breastbone, a restriction in breathing, and it is so deep that he can no longer go further, but must sit down …

Nadir Akhmedzhanov: Yes, he must sit down stop.

Olga Beklemishcheva: Is this a very serious call?

Nadir Akhmedzhanov: Yes, that’s right. Now, if, for example, a person with a very high physical exertion suddenly felt a retrosternal heaviness, compression, then this is also the first occurrence of angina pectoris, but it carries a much lower risk of developing a heart attack than that angina pectoris, which during normal physical exertion … happily with a person, and suddenly, going to work in the morning (and he is, say, 50 years old), for the first time was forced to stop from some incomprehensible, squeezing sensation in the chest.This first-onset angina pectoris, in fact, during normal physical activity, it significantly, significantly increases the risk of developing a heart attack. Therefore, this is just the first emerging, unstable angina.

Olga Beklemishcheva: Please note, dear listeners, that if, against the background of general well-being, there are unpleasant sensations behind the breastbone, this is a very serious symptom.

So, there is angina pectoris for the first time. And when does it exist for a sufficiently long time?

Nadir Akhmedzhanov: For example, a person has angina pectoris for the first time.And then there are two ways of development: either it acquires a sharply progressive character …

Olga Beklemishcheva: … and quickly moves towards a heart attack.

Nadir Akhmedzhanov: Yes, he is heading for a heart attack. Or the situation will stabilize on its own, and a person in the future can live with angina pectoris for years, decades, and adapt. This is the situation of stable angina pectoris. But periodically against the background of this stability there may be episodes of instability, which again…

Olga Beklemishcheva: … are fraught with risks.

Nadir Akhmedzhanov: Yes, they dramatically increase the risk of heart attack. And in such situations, you must definitely contact your doctor, say that the situation has changed. Let’s say that a person has always walked a certain number of floors, meters – and everything was fine. And when suddenly, for some unknown reason, physical activity sharply decreased in him – they do not give him attacks of angina pectoris, or they began to appear at rest – this is also a very alarming symptom: when they were never at rest, and suddenly a person is watching TV… Although this is also, of course, relative peace. There is some kind of emotional transmission …

Olga Beklemishcheva: FIFA World Cup, right?

Nadir Akhmedzhanov: Yes. But this is actually an attack of angina pectoris, because a person develops tachycardia …

Olga Beklemishcheva: He is experiencing.

Nadir Akhmedzhanov: Yes, he is worried.But when there seems to be no visible provoking factors, but angina attacks appear at rest, then in this case the risk of developing a heart attack also sharply increases. Therefore, this condition is called just “unstable angina”, and now there is still the concept of “acute coronary syndrome”.

Olga Beklemishcheva: Well, yes, now there are a lot of terminological innovations, I would say so.

And we all know that angina pectoris is somehow diagnosed, investigated, there are some kind of stress tests, stress tests.And what is the physiological basis really? So I come, for example, to a doctor with a complaint about some situation, about discomfort in the chest area, in the heart area, what tests do I need to pass in order to know for sure that it is angina pectoris?

Nadir Akhmedzhanov: In fact, angina pectoris … most, let’s say, the diagnosis can be made on the basis of a competent survey. Most of the diagnosis is a competent survey. But additional methods of examination are also needed, which confirm the opinion of the doctor.First of all, of course, it is to take an electrocardiogram. Because on the electrocardiogram, if you take it off … let’s say, at this time, say, there was an attack of angina pectoris, then there may be changes that are characteristic precisely for an attack of angina pectoris.

Olga Beklemishcheva: This is, first of all, a change in the ST segment, right?

Nadir Akhmedzhanov: Quite right. The second is an exercise test.What is the essence of the sample? The test simulates, artificially creates situations of physical activity in a dosed manner, under the control of an electrocardiogram. And when a person runs along the path or pedals, a situation is artificially caused to him when the heart needs more blood, and, accordingly, it cannot be delivered through the narrowed lumen of the vessel. And this is what was said – a cry of the heart for help. What’s going on? An attack of angina pectoris occurs – this is a call to the heart to stop, or there are changes in the electrocardiogram.And actually, for the sake of this, a load is being carried out – to objectify, that is, not only on the basis of a survey. This test is safe because it is carried out according to certain rules, under the control of instruments.

In addition, the significance of this test increases even more not only by electrocardiographic control and by well-being, but also when you can see how the heart itself behaves in this case.

Olga Beklemishcheva: In dynamics.

Nadir Akhmedzhanov: Yes, in dynamics. After all, when the heart suffers, there is a lack of blood supply. And this part of the heart begins to contract worse. How can this be registered? This can be recorded by taking an echocardiogram at the time of loading.

Olga Beklemishcheva: Yes. Because at rest, even if you have angina, the ECG can be pretty decent.

Nadir Akhmedzhanov: Yes.And the echocardiogram will also be normal. But if, for example, you combine a test with physical activity … or physical activity, let’s say, is replaced, simulated with special pharmacological tests, that is, special drugs are introduced, which again create a kind of load for the heart …

Olga Beklemishcheva: Ischemia situation.

Nadir Akhmedzhanov: … yes, and at the same time either an echocardiogram is recorded, or a radioisotope marker is introduced, thallium is introduced.And the area that suffers can be seen either when examined with thallium, or a violation of the contractile function of the myocardium is seen on ultrasound. These are just the main methods of diagnostics.

In addition, in such a situation, a blood test is required to determine the level of cholesterol, since the basis of the plaque is cholesterol. Therefore, without cholesterol, there is no atherosclerosis.

Olga Beklemishcheva: But you also talked about the cold test.What is it?

Nadir Akhmedzhanov: Cold test, yes. Now, if there is a suspicion that the patient has a significant contribution … a change in the vascular tone, then what I spoke about, in extreme terms, is vasospastic angina. But sometimes ordinary angina pectoris is combined with spastic angina pectoris. That is, there is some component. In such a situation, electrodes are sometimes applied and the patient’s hand is asked to be dipped into an ice porridge. And if this vasospastic component is significant, then an attack of angina pectoris may occur.By the way, many patients themselves carry out this test virtually involuntarily when they leave a warm room in winter, and especially when the wind blows in the face, in fact the patient leaves a warm room, he inhales cold air, and many know that this causes an attack of angina pectoris … Therefore, by the way, there is a simple method to prevent this. Before leaving a warm room in winter, it is better to take a Nitroglycerin tablet prophylactically – and then this attack will not happen.

Olga Beklemishcheva: And now to the issue of nitroglycerin.This is also one of the main participants in diagnostic tests, well, in any case, those that we do ourselves. That is, if you are in a situation where you have a heaviness behind the breastbone, some pain, numbness, take Nitroglycerin – and it helps you, then most likely it is angina. This is true?

Nadir Akhmedzhanov: Yes, that’s right. Let’s just say, if an attack of angina pectoris is suspected, then in response to taking Nitroglycerin, an attack of angina pectoris should pass.Usually an attack of angina pectoris lasts no more than 10-15 minutes. Therefore, in these intervals, an attack of angina pectoris should pass. It’s like a differential diagnostic test. If this is not associated with angina pectoris, then, as a rule … for example, cardialgia, that is, pains of a different nature in the region of the heart … by the way, then the patient can show for sure, for example, some point hurts, and this is not angina usually happens. So, in such a situation, Nitroglycerin does not work. Even sometimes the patient may say that it has gotten worse.So if Nitroglycerin helps, this is a very important point in the differential diagnostic that it is most likely angina pectoris. Another thing is that sometimes Nitroglycerin helps not with angina pectoris.

Therefore, to summarize, let’s say, if it is angina pectoris, then Nitroglycerin should definitely help, and if Nitroglycerin helped, then most likely it is …

Olga Beklemishcheva: … angina pectoris, but not necessarily.

Nadir Akhmedzhanov: Yes.

Olga Beklemishcheva: Well, in my opinion, we have somehow figured out the differential diagnosis.

And now we come to the most essential point – this is precisely the treatment. We have already started talking about Nitroglycerin, and this is probably the most well-deserved medicine, and it will probably soon be possible to erect a monument to him, like Aspirin. So?

Nadir Akhmedzhanov: Certainly. Both Aspirin and Nitroglycerin are outstanding drugs.Only there is a significant difference between them. Aspirin, for example, it improves the patient’s prognosis, that is, it reduces the risk of subsequent heart attacks, say, in a patient with angina pectoris. But Nitroglycerin, it significantly improves well-being, many patients cannot do without it, but it does not affect the prognosis in any way.

Olga Beklemishcheva: That is, he does not heal?

Nadir Akhmedzhanov: He removes the symptom, removes the pain.That is, it is an absolutely necessary medicine.

Olga Beklemishcheva: Yes, why torture a person …

Nadir Akhmedzhanov: Yes, this is an absolutely necessary and outstanding drug. And Aspirin, on the contrary, does not directly affect the state of health. Its dose is enough, according to modern recommendations, to drink 75 milligrams per day, and this significantly reduces the risk in patients in the subsequent development of complications.

Therefore, the treatment is directed at different aspects. One aspect is relieving an angina attack. Another aspect is improving the forecast. And here are different drugs …

Olga Beklemishcheva: Prevention of just this most formidable complication – a heart attack.

Nadir Akhmedzhanov: Absolutely correct. And here, just if you take drugs that relieve an attack of angina pectoris – and these are nitrates, these are calcium antagonists that reduce the severity of angina pectoris, these are beta-blockers.And there are drugs that improve the prognosis – this is, say, Aspirin, these are drugs that are now given, perhaps, the greatest importance – these are statins, which actually fight atherosclerosis, so they make the greatest contribution to improving the prognosis of patients. Well, if a person has already suffered, say, myocardial infarction, he has angina pectoris, then the necessary component is an angiotensin-converting enzyme inhibitor, well, beta-blockers. If a person has angina pectoris, and he has suffered a myocardial infarction in the past, then he must definitely take beta-blockers.And one more component. If a person has suffered a myocardial infarction, and he, say, has angina pectoris, and in the past had a myocardial infarction, then he still needs Omega-3 polyunsaturated fatty acids to improve the prognosis.

Olga Beklemishcheva: Yes, this is the latest novelty.

Nadir Akhmedzhanov: Yes. Just not a food supplement, but a drug. And there is only one drug, which is why it is written in the recommendations – Omacor, because this is a medicine.And the rest of the dietary supplements are not drugs.

Olga Beklemishcheva: They, unfortunately, were not tested in a harsh way on a large number of patients. And that’s why, probably, they are doing something, but we cannot say with complete certainty what exactly.

Nadir Akhmedzhanov: Quite right.

And there is one more aspect. Some patients need surgical treatment.

Olga Beklemishcheva: Here! Here we also come to a very important point, because it seems – what is angina pectoris? – this is the heart, it feeds through the coronary vessels, the coronary vessels depart from the aorta almost next to the heart and return there.And in this place, probably, the presence of a plaque somehow worsens hemodynamics, and this is completely understandable. If we have a pipe and we put something in there, then, naturally, everything will flow worse there. And now our brothers-surgeons have been offering vascular plastics for many years, that is, either a stent is inserted there, or coronary artery bypass grafting is performed, which, in theory, improves hemodynamics. But therapists, as I understand it, have their own point of view on this issue.

Nadir Akhmedzhanov: Now, indeed, there have been very significant shifts in the question: who and how to treat, what to choose for the patient? Well, first of all, of course, the fact that at one time coronary artery bypass grafting, balloon angioplasty were invented, then stent placement, this revolutionized treatment, no doubt.And after the appearance of these procedures, the number of cases when they began to be treated with a surgical method – this is coronary artery bypass grafting – has sharply increased. There are various techniques. For example, a vein is used as a shunt. There are own arteries. That is, surgeons already have a very wide range of technical capabilities. They perfectly do these operations all over the world. And in some cases, the patient simply cannot do without them. For example, there are some lesions – localization of an atherosclerotic plaque, and only surgeons can actually save.

Then balloon angioplasty appeared, when you don’t need to make an incision, a puncture …

Olga Beklemischeva: And you just come to the narrowing site with a catheter and pump a balloon at the end of the catheter with an enema.

Nadir Akhmedzhanov: Quite right. And by the evening the patient can go home. And then, so that the vessel does not collapse again, there is also a stent …

So, all these methods are absolutely necessary.And drug treatment, and balloon angioplasty, and surgical treatment – each of these methods has its own ecological niche. What has been happening lately? Recently, there has been a friendly, maybe, struggle. Surgeons believe that more shunts need to be done, and those who do angioplasty – that more plastic needs to be done. Therapists say more active treatment is needed. Here are three points of view.

Olga Beklemishcheva: And now I propose to listen to medical news.

The 17th World Water Week has ended in Stockholm. Swedes continue to demonstrate their commitment to environmental protection. This week, more than 2.5 thousand experts from 140 countries of the world gathered in Stockholm to once again discuss the prospects for preserving clean water in sufficient quantities on the planet for the needs of future generations. On August 16, King Carl Gustav 16 of Sweden presented Professor McCarthy from Strandfordshire University (California, USA) with the award, which is presented to people and organizations that have made a significant contribution to the protection and preservation of clean water.Professor McCarthy was awarded the prize for his invention of biofilm reactors suitable for high purification of industrial effluents and water contaminated with biological residues.

It is equally important to fight for clean air. For the first time, Taiwanese scientists from the National University College of Health investigated the effects of air pollution on cardiovascular risk factors in young people. Blood tests and cardiograms were taken from 76 healthy students for three months.In parallel, the composition of the air was analyzed for the presence of pollutants. It turned out that particulates of sulfate, nitrates and ozone led to the activation of the blood coagulation system, changes in the autonomic nervous system of the heart and significantly increased the risks of developing cardiovascular disease in young, healthy people.

A new report from the American Medical Association on salt guidelines. Dr. Barry Dickinson and Dr. Stephen Hawas (American Medical Association, Chicago, Illinois) recall that observational studies and randomized clinical trials show that reducing salt intake leads to lower blood pressure.So, a decrease in daily salt intake by only 1.3 grams prevents an increase in systolic pressure by 5 millimeters in people 25-55 years old. At the population level, this means a decrease in the prevalence of hypertension by 20 percent, a decrease in mortality from coronary heart disease – by 9 percent, from stroke – by 14 percent, from all causes – by 7 percent, saving up to 150 thousand lives annually, scientists say. Moreover, in populations with a salt intake of less than 1.4 grams per day, there is practically no age-related increase in the frequency of hypertension or an increase in blood pressure.Therefore, there is a safe threshold for salt intake beyond which negative cardiovascular effects begin to manifest. However, around the world, most people consume 2.3-4.6 grams of salt per day. In the same countries where governments control the salt content of food, there are positive changes. For example, in Finland, where the ratio of sodium and potassium intake from food has been monitored, since 1972, diastolic pressure in the population has decreased by 10 millimeters of mercury, and mortality from stroke and coronary heart disease among 30-59-year-olds has decreased by 60 percent.

Every day in Russia 110 people are infected with the AIDS virus, and 40 percent of them are ordinary people who have no relation to drugs or non-traditional sexual orientation. These figures were announced by Dmitry Golyaev, project director of the Russian Health Care Foundation, at a press conference dedicated to the preparation of the All-Russian STOP AIDS rally. As of today, 362 thousand HIV-positive people are officially registered in Russia, and it is expected that by the end of the year their number will increase to 400 thousand.According to Golyaev, in fact, there are about a million HIV-infected in Russia, since official statistics lag behind reality. The expert recalled that if the number of infected exceeds 10 percent of the population (1 million 400 thousand people for Russia), a “generalized epidemic” may arise, threatening the country’s security. Currently, about 30 thousand people are receiving antiretroviral therapy – approximately one tenth of all HIV-infected citizens of Russia.

Olga Beklemishcheva: And we will continue this wonderful topic on which we stopped.I mean a kind of controversy that has arisen now about surgical methods of treating angina pectoris and coronary heart disease and therapeutic. Moreover, the intensity of the controversy is such that even evil tongues say: “Who is indicated for coronary artery stenting and bypass grafting? Someone who has money. ”

Nadir Migdatovich, what do you think?

Nadir Akhmedzhanov: I believe that each of these methods is absolutely necessary. Another thing is that not always, perhaps, we find the right ecological niche for each of these methods.The fact is that in a number of patients, both bypass grafting and stenting prolong life. But there is a category of patients who can be treated therapeutically, surgically, and by stenting. In this case, shunting, or stenting, it does not prolong life, but improves the quality of life.

Olga Beklemishcheva: And how significantly does it improve the quality of life?

Nadir Akhmedzhanov: There is a big question here – how important it is.And just recently, by the way, a large study in America ended: 5 thousand patients were followed up for five years. This research is called “Courage”. And it made a very big impact in America. It turned out that the results of treatment of stable angina pectoris by stenting or in comparison with adequate, well-chosen drug therapy did not differ in prognosis for the patient: the life expectancy was the same, the frequency of complications was the same. But the quality of life is somewhat better in those who underwent stenting.

Therefore, when a doctor talks to a patient, it is necessary to explain what gives him in addition … In some cases, this prolongs life.

Olga Beklemishcheva: And what exactly are these cases?

Nadir Akhmedzhanov: These are the cases when the so-called stenoses are located in the main trunk of the left coronary artery, or there is a concept of equivalents of these … high proximal stenosis of the circumflex artery, the anterior outgoing artery is the equivalent of the base of the trunk of the stenosis.In such cases, the operation, it is the drug of choice, and it prolongs life in such a situation. Or, for example, high proximal stenosis of the anterior outgoing artery. In such a situation, stenting will be better than drug therapy. But in many cases it is possible to treat both the patient and the other. The patient must choose for himself …

Olga Beklemishcheva: Is it when there is not such a large stenosis or when it is not so close to the main trunk?

Nadir Akhmedzhanov: Quite right.When it is not that big and when it is not so close. Here you can be treated with medication, surgery, and stenting, depending on which method is preferable. And this patient should know what the intervention gives him in such a situation.

Sometimes we all suffer from the fact that we do not completely choose all the possibilities of drug therapy and believe that our therapy does not help the patient. But we simply do not prescribe the necessary, adequate doses of drugs. And we all need to pay attention to this – both doctors and patients.And in such a situation, everyone will have a place – both therapists and surgeons, and angioplasty with stenting …

Olga Beklemishcheva: And there will be fewer unjustified surgical interventions.

Nadir Akhmedzhanov: Absolutely correct. Because then we will be able to simply do all these interventions to those who are vitally needed.

Therefore, there really is a contradiction, and in a number of cases there are very heated disputes.But all this can be directed in a very peaceful and constructive direction.

Olga Beklemishcheva: God grant!

And now we are answering our listeners. And the first to call was Valery Arkadyevich from the city of Korolev. Hello, Valery Arkadyevich.

Listener: Hello. Regarding surgery, these two methods. Firstly, you don’t really have a rating of these procedures. The patient is gone – and you don’t really know… Because these statistics are probably disappearing.

But I have a different question, and a very specific one. Please tell me, here are the therapeutic methods for lowering the lower pressure … How effective they are – it is clear there. And there are many options. Tell me, which ones are the best? And in this regard, let us recall the good old – this is the theory of Dr. Zalmanov. How do you feel about this wood – to larch, to dihydroquercetin, which is produced under the name “Capillar”, and in the city of Pushchino also? Thanks.

Nadir Akhmedzhanov: Thank you for your question. Capillar does not have any evidence of its effectiveness, which would be carried out according to international standards that are required for a drug. Therefore, I cannot comment on the effectiveness of Capillar, give any comments, as about a drug. It does not apply to drugs.

As for lowering blood pressure, the decrease in systolic blood pressure is of greatest importance, and diastolic pressure is of lesser importance.Your question is understandable, because it used to be thought that diastolic pressure is more important. No, systolic blood pressure is more important. And which method to choose – it is only the doctor who can decide individually. Here, any of the methods … The main thing is to lower blood pressure, and how to lower it – this will be decided by the attending physician.

Olga Beklemishcheva: Because what suits one person does not suit another.

Nadir Akhmedzhanov: Quite right.

Olga Beklemishcheva: And the next listener is Valentin from Ryazan. Hello Valentine.

Listener: Hello. I would like to know what to do with acquired hypoplasia? And should I drink, generally speaking, statins? Thanks.

Nadir Akhmedzhanov: Acquired hypoplasia of what? Here I do not quite understand the question.

Olga Beklemishcheva: Valentin, unfortunately, hung up.But I think that he will call us and clarify what kind of hypoplasia he has in mind.

But the question on statins is correct. Because, judging by various reports, the world continues to investigate the need for statins and their effect on the prognosis, that is, on the number of years of life that they add. And so, in fact, judging by the literature, not everything is clear there.

Nadir Akhmedzhanov: All over the world, in fact, there is no doubt about the need to use statins in a very wide range of patients, and not only in patients with already existing atherosclerosis, but also in patients without clinical manifestations ischemic heart disease, for example, with arterial hypertension, with diabetes mellitus.And when there is atherosclerosis, no one in the world doubts that statins are vital. And it’s just statins to the greatest extent of all drugs reduce the risk of complications. Therefore, statins are an absolutely necessary component of the treatment of a patient with angina pectoris. Now in no country in the world it is impossible to imagine treating a patient with angina pectoris – whether it is a patient who is being treated with medication, whether it is a patient who has undergone shunting or stenting – without the use of statins.What statin and in what dose is the doctor’s choice. But in appointments to a patient with angina pectoris, it must be mandatory … unless, of course, there are contraindications for the use of statins, statins must be prescribed to every patient with angina pectoris. Regardless, by the way, on the level of cholesterol. Even if it is normal, it still needs to be reduced by at least 30 percent.

Olga Beklemishcheva: Dear ones, they are very much …

Nadir Akhmedzhanov: Well, here this problem, unfortunately, exists, yes, I must admit.And they are expensive all over the world. But now there is a solution to the problem – the so-called generics are copies of the original drugs …

Olga Beklemishcheva: Which are produced in Southeast Asia, as always, right?

Nadir Akhmedzhanov: The question is this. These drugs are subject to our Russian control methods. Therefore, it does not matter where the drug is produced, but if it has passed our Russian required control methods, it means that it meets the standards.Therefore, such a drug must be recognized as effective.

Olga Beklemishcheva: And as far as I know, generics are less often counterfeited, falsified, because they are cheaper – and this is not so profitable.

Nadir Akhmedzhanov: Well, apparently yes. From the point of view of this logic, most likely it is so. Because it is profitable to counterfeit expensive drugs, while cheap drugs are counterfeited …

Olga Beklemishcheva: It’s just that many familiar doctors complain that already with the usual, so to speak, therapy, suddenly some kind of failure in the effect is discovered …And then, for your own money, you take this drug to the laboratory – and it turns out that it is just chalk. Unfortunately, there are a lot of counterfeit medicines. And keep this in mind, dear listeners. Do not rush to immediately blame medications for not helping you. Perhaps, unfortunately, this active principle is simply not there.

And the next listener is Anna from Moscow. Hello Anna.

Listener: Hello. I want to share my own experience.Two years ago, after suffering a serious illness, I noticed that I had unpleasant sensations in my heart when walking, and especially when lifting weights, the inability to climb stairs. And I thought: “Really – angina pectoris? ..”. However, the survey was not carried out. And once, while walking, I had to stop and think: “Well, that’s it, it’s bad.” And then I remembered that I had recently read about the Buteyko method, how it helps in such troubles. And right there on the spot, I held my breath on the exhale, as expected, began to teach myself to extend the exhalation.This attack immediately disappeared from me, and it never happened again from that moment. I just started practicing this long Buteyko exhalation. And against this background, my health began to improve, my heart returned to normal, began to walk up the stairs – and everything is fine.

Nadir Akhmedzhanov: Well, it’s very nice that it helped. But, most likely, and fortunately, this is probably still not angina pectoris in you.

Olga Beklemishcheva: By the way, you can visit the website of the Buteyko Clinic in Moscow… Our program included the director of this clinic, Novozhilov. And he just says: “Yes, we help with angina pectoris. But we better help with other forms of cardialgia. ”

But, in any case, if it helped – great!

Nadir Akhmedzhanov: Very good, of course.

Olga Beklemishcheva: And we are listening to Valeria from the Moscow region. Hello Valeria.

Listener: Hello.My husband is 52 years old and overweight. He went to have his heart checked, to have a cardiogram – he has an overload of the left ventricle. And the pulse is constantly accelerated, that is, more than 100, reaches 115. The doctors prescribed the drug Concor and Noliprel. And his joint is inflamed, such as gout or arthritis. Could it be from Concor or Noliprel?

Olga Beklemishcheva: Thank you, Valeria.

Nadir Akhmedzhanov: The question is really very topical.Well, the point is, it hardly has anything to do with Concor and Noliprel. These are two very good remedies. And judging by your description, they were assigned absolutely correctly. And the fact that the joint is inflamed is, apparently, for other reasons. At least, there is no obvious connection with the appointment of Concor and Noliprel – and these are very good and effective drugs – in this case … based on the information that was presented.

Olga Beklemishcheva: Nadir Migdatovich, but in general, of course, with angina pectoris, if it is prolonged, even stable, and we constantly use some drugs, then, probably, some of their side effects arise, and they accumulate.Which are the most common ones? And what should be considered during long-term therapy of angina pectoris?

Nadir Akhmedzhanov: With long-term therapy of angina pectoris … Well, the question is very broad, so it is difficult to answer it unequivocally and quickly. Because angina pectoris is treated with different classes of drugs, and each class of drugs has its own side effects. Let’s say beta blockers have side effects …

Olga Beklemishcheva: Well, okay.And in your practice, what complication of long-term therapy of angina pectoris do you most often encounter?

Nadir Akhmedzhanov: It depends on the drug, which drug is being treated. If, for example, a person takes, for example, calcium antagonists. When taking calcium antagonists, you may experience pastiness, swelling of the legs, well, for example. If we are talking, for example, about beta-blockers, here a person takes beta-blockers, then sometimes there may be nightmarish dreams, this is rare, but it does happen.Or, say, there may be cold extremities when beta-blockers are prescribed. Each drug has some side effects. For example, even if a person takes Aspirin, he may have stomach problems. Therefore, if we are talking, say, about statins, then with statins, muscle weakness can be observed – in rare cases, about 10 percent. For example, if a person takes Omega-3 polyunsaturated fatty acids, then some have a fishy smell, this is rare, but observed.That is, each drug that is included in the treatment of angina pectoris may have side effects inherent in this drug. And if Nitroglycerin – then a headache. And there is a property of addiction to Nitroglycerin, and the effectiveness decreases as a person takes Nitroglycerin for a long time. Therefore, by the way, it is not necessary to take it constantly. It should only be taken to control seizures or to prevent an anticipated seizure.

Olga Beklemishcheva: In any case, among all this list that Nadir Migdatovich announced to us, there is no joint pain or any serious, acute, life-threatening conditions.

And Valentin from Ryazan called us again. We’re listening to you, Valentine.

Listener: I have “hypoplasia, acquired from the segment,” as I was told, not congenital.

Olga Beklemishcheva: What segment?

Listener: Well, it says “starting from the segment”.

Nadir Akhmedzhanov: You know, from this information it is not clear what the segment is.

Olga Beklemishcheva: Obviously, you have an ECG … but there are several segments. And it is not entirely clear what this is about.

Nadir Akhmedzhanov: Yes, it is impossible to comment.

Olga Beklemishcheva: And we will also talk about atypical manifestations of angina pectoris and some features of its course. Because we have already said that, in reality, angina pectoris often manifests itself as some kind of unpleasant sensation in the chest, but there are special cases, and they are especially characteristic for older people when it does not look like angina pectoris.Is that so, Nadir Migdatovich?

Nadir Akhmedzhanov: Indeed, older people sometimes have a picture, maybe not quite clear, because maybe there are no such vivid manifestations. And then, older people have not only angina pectoris, but also osteochondrosis. Therefore, in the elderly, a combination is more often observed – and an attack of angina pectoris may be, and in addition, there may be pains, which are also in the chest, but which are not caused by angina pectoris, but by osteochondrosis, neuralgia.And sometimes it is for the doctor, indeed, and for the patient himself, it is a problem, since he really has angina pectoris and, indeed, there are problems with other painful sensations in the chest. This is just typical, of course, for elderly people, because we have sores with age, and not diminish.

Olga Beklemishcheva: But there is still a kind of increased tolerance of elderly patients to pain syndrome.

Nadir Akhmedzhanov: Quite right.

Olga Beklemishcheva: That is, they, on the contrary, don’t notice … when time has already passed. Therefore, right here, if the patient knows that he has coronary heart disease, angina pectoris, and if Nitroglycerin does not help, if the attack does not go away, then it is not necessary to delay, but an urgent need to call a doctor if the usual for this patient does not help methods.This is, indeed, a very important problem that sometimes patients think that everything will pass by itself. And if it does not go away, then you need to see a doctor.

Olga Beklemishcheva: Yes, let the “ambulance” come once more, just to not miss a heart attack.

And listening to Tatiana from Moscow. Hello Tatiana.

Listener: Good afternoon. I would like to ask Dr. Akhmedzhanov, is it possible to get to him with his testimony according to the heart for an appointment, for a consultation?

Nadir Akhmedzhanov: Please.Address: Petroverigsky lane, 10, this is the Kitay-Gorod metro station, the State Center for Preventive Medicine. You will come – and at the reception they will just write you for a consultation.

Olga Beklemishcheva: This is not far from the metro.

And listening to Alexander from Moscow. Hello, Alexander.

Listener: Hello. Please tell me if Thrombo ACC is well tolerated, then what is the duration of his courses, or is it generally constant?

Nadir Akhmedzhanov: If we are talking about coronary heart disease, then Thrombo ACC in a small dose should be taken constantly.This is not a course treatment, but a permanent one. The dose is small – 75-100 milligrams per day.

Olga Beklemishcheva: In fact, this is the therapy that is inherent in angina pectoris, namely angina pectoris, as one of the “subdivisions” of coronary heart disease, is it a course or permanent?

Nadir Akhmedzhanov: The therapy that is aimed at improving the prognosis, as we talked about, is permanent.

Olga Beklemishcheva: This is Aspirin…

Nadir Akhmedzhanov: Aspirin, statins, Omega-3 polyunsaturated acids … This is for those who have suffered myocardial infarction. Both beta blockers and angiotensin-converting enzyme inhibitors. Here are five components … This is ongoing therapy. And therapy aimed, in fact, at increasing exercise tolerance, is as needed. These are calcium antagonists, these are nitrates, which reduce the likelihood and severity of the occurrence of angina attacks.And nitrates generally do not need to be drunk constantly, I mean – every day, but drink, as already mentioned, either to stop an attack of angina pectoris, or before expected loads. Let’s say a person goes to work or for some other business, and he can drink Nitroglycerin in advance. And if there is no load today, for example, he will be at home all day, then Nitroglycerin can not be drunk.

Olga Beklemishcheva: So I imagined that if we take into account the patient’s age and the recommendations that were made in previous programs: before leaving the house, you put on a corset – to prevent an attack of osteochondrosis, you drink Nitroglycerin – to prevent angina pectoris… But in order not to bring it to this, are there any general principles for the prevention of cardiovascular diseases and their complications?

Nadir Akhmedzhanov: Yes, they are. And if we are talking about the main points of prevention … Well, we cannot affect our heredity, this is individual. But here’s what I would like to pay more attention to – smoking cessation (and this is the most powerful factor, the so-called modifiable), control cholesterol levels and observe…

Olga Beklemishcheva: And how often do you need to be tested for cholesterol?

Nadir Akhmedzhanov: After 20 years, if a person does not know the level of cholesterol, then it must be determined. If it is normal, then the next time – in five years it needs to be determined. If it is elevated … The total cholesterol level in a healthy person should be less than 5 millimoles per liter, and in a patient with coronary heart disease, with angina pectoris, the total cholesterol level should be less than 4.5 millimoles per liter.And low-density cholesterol, the most atherogenic, should be less than 2.5 in a patient with ischemic heart disease, with angina pectoris.

Olga Beklemishcheva: And how often after 45-50 years you need to find out …

Nadir Akhmedzhanov: Once a year you need to determine it. It is not necessary to define more often. If it is elevated and if manipulated with it – whether it is dietary controlled, then whether it is controlled – if a patient with coronary heart disease – with the help of statin drugs.

And, of course, also control blood pressure.

Olga Beklemishcheva: These are two basic principles that would be good to observe.

And I thank our guest for participating in the program.

All the best to you! Try not to get sick.

Nitroglycerin overdose: how many tablets, consequences

About the drug

Nitroglycerin is a chemical compound of glycerin with nitric acid.From the Latin name of the last substance – acidum nitricum, the drug received its well-known name.

In the 19th century, this substance was used as an explosive. In the future, a number of studies were carried out with the involvement of volunteers, which helped to discover and prove the effect of the drug in relieving heart pain, lowering blood pressure. Then he was officially recognized as a drug.

The drug is used in cardiology – it increases blood flow, dilates blood vessels, which reduces pressure, eliminates painful sensations.Nitroglycerin is also used to calm intestinal and hepatic colic, as it has a relaxing effect on the muscles of the gastrointestinal tract.

This drug is not used to treat the cause of the disease, but only to relieve symptoms. All because of a short, albeit quick effect.

The drug is produced in three forms: capsules, tablets and alcohol solution. A nitroglycerin tablet is placed under the tongue, not exceeding the number of 6 pieces per day. Alcohol drops, taken in an amount of no more than 3 per sugar cube.The daily dose is 15 drops. Improvement occurs in two minutes, the duration of exposure is about an hour.

The intensity of administration and dosage of the drug is determined by the doctor, because it all depends on the nature and severity of the disease. Improper home treatment often causes fatal nitroglycerin poisoning.

Lethal dose

At one time, a minimum of 0.5 mg and a maximum of 1.5 mg of nitroglycerin are prescribed. Specialists to relieve an acute attack of pain carry out treatment according to the scheme: within fifteen minutes, take 3 tablets.This technique is carried out in the absence of improvement after one tablet, the next dose is taken every five minutes. It is impossible to shorten the time regime; it is also prohibited to take more than three tablets at a time.

After taking four tablets or more, with a violation of the time interval, the first signs of an overdose of nitroglycerin appear. Taking the drug more than 20 mg of a substance per kg of body weight – leads to severe intoxication with nitroglycerin. Death occurs when the concentration in the blood is 100 – 130 mg of the substance.

Nitroglycerin overdose rarely occurs in hospitals when the drug is administered intravenously, since doctors carefully calculate not only the dosage, but also the rate of its administration.

What side effects can there be?

Nitroglycerin intoxication is dangerous both due to the intake of a lethal amount of the substance and side effects that can increase unpredictably.

Side effects:

  • Dizziness. This is one of the first adverse reactions with general debility.
  • Blood rushes to the upper part of the body. The face turns red.
  • Skin rashes. Allergy from an overdose manifests itself in the form of a rash, cases of anaphylactic shock and Quincke’s edema are not uncommon.
  • Headaches. In the first days of using the drug, patients notice frequent migraines.
  • Reduction of blood pressure, which occurs sharply, which is life-threatening.
  • Loss of visual acuity. This side effect is temporary and vision is quickly restored.

Experts strongly recommend seeking emergency medical help if the patient’s condition has not improved after taking three pills. Since taking the next dose, with a high degree of probability, will lead to undesirable consequences in the form of an overdose.

Contraindications for use

Due to the large number of dangerous side effects of overdose, there are restrictions on the intake of this drug.


  1. Damage to blood vessels.
  2. Intracranial pressure. Ingestion of the substance causes a rush of blood to the face and neck.
  3. Damage to the heart muscle. With an exacerbation of coronary artery disease, this drug should not be taken. And in the event of pain in the heart and other symptoms, they call an ambulance team for proper treatment.
  4. Hypertension.
  5. Children’s age. For the treatment of angina pectoris in children, complex therapy is used, a qualified specialist will not prescribe nitroglycerin in this case.
  6. During pregnancy, lactation.How nitroglycerin affects the body of the mother and child during pregnancy remains a mystery. It is prescribed if the benefit to the mother significantly outweighs the risk to the health of the child.

Symptoms of nitroglycerin overdose

Excessive doses of drugs for treatment are not beneficial. Signs of nitroglycerin overdose will not be long in coming.


  • Shortness of breath and dizziness. These symptoms appear first.A person develops weakness, loss of consciousness.
  • Blue lips, nails. Be sure to pay attention to this symptom. If such manifestations occur, cyanosis of the palms, nails and lips, call for emergency help.
  • Disruption of the digestive tract. The patient complains of dry mouth, nausea, vomiting opens.
  • Increased body temperature. This symptom of an overdose is accompanied by the appearance of cold perspiration and chills.
  • Convulsions. After a convulsive syndrome, intracranial pressure rises.
  • Tremor. Trembling of the upper and lower limbs.
  • Orthostatic collapse. This is the most dangerous consequence of exceeding the permissible dose.

If a person takes 200 mg of nitroglycerin, then death from an overdose of nitroglycerin occurs no later than two minutes.

First aid and treatment for poisoning

An overdose of nitroglycerin requires urgent assistance. It will be useful for everyone to know how to help a person who has suffered from intoxication of the body.

First aid in case of overdose:

  1. The patient is placed on a flat surface and his legs are raised to an elevation.
  2. Open windows or take him outside so that the victim can breathe fresh air.
  3. Taking into account the patient’s condition, wash the stomach with warm water.
  4. Measure blood pressure and pulse.
  5. After washing, the victim will benefit from a viscous drink – jelly. Acetylsalicylic acid will help to cope with increased body temperature.For nausea, activated carbon and validol are used.

The legs are lifted to improve blood circulation to the heart and brain, since the reduced pressure leads to a collaptoid state.

Treatment at home is impossible, the patient is unconditionally hospitalized for intensive care. With the help of special drugs, the patient’s vascular tone is increased, the volume of blood supply is increased.

Medical help is needed if:

  • A pregnant woman or a small child is injured;
  • The patient has lost consciousness;
  • Skin, nails and palms turn blue;
  • Blood from vomiting or stool;
  • Blood pressure drops sharply;
  • Tachycardia, palpitations;

Consequences and prevention

One of the severe consequences of an overdose of the body is a collaptoid state, with the development of acute circulatory failure, the victim falls into a coma.If qualified assistance is not provided in a timely manner, an overdose is fatal.

If you take the drug for a long time, symptoms such as weakness, migraine, dry mouth, temporary loss of vision, skin rash occur.

With regard to prevention, it is possible to prevent an overdose of nitroglycerin. It is necessary to appoint a specialist, where the permissible dosage and mode of administration will be indicated. If an attack occurs, you can not take more than three tablets, and the lack of effect indicates the need to consult a doctor.

For what purpose is it used?

What is nitroglycerin? Instructions for use (tablets with this name are sold in all pharmacies) claims that this is a fairly popular medicine that belongs to the group of vasodilators, that is, substances that dilate blood vessels. It is actively used in cardiological practice, and sometimes in gastroenterology. So what does the drug in question work for?

What are the indications for the use of Nitroglycerin

Nitroglycerin has different indications for use.A detailed description of the drug can be found in the instructions for use. The drug has a quick effect, which consists in vasodilation and relief of a painful attack in the area of ​​the heart muscle. As soon as the active substance enters the mucous membrane, it is absorbed into the bloodstream and begins to act. The first effect of the drug is noticeable within a minute or two after administration.

Basic properties of the drug

Nitroglycerin release form solution, tablets, capsules, has a number of basic positive effects that are on the human body.

Among such actions are the following:

  1. Expansion of blood vessels.
  2. Relaxation of smooth muscle walls.
  3. Reduction of venous blood flow to the heart.
  4. Correct distribution of blood in the myocardium.
  5. Reduction of damage in the development of a heart attack.
  6. Improvement of myocardial function.
  7. Improving metabolic processes in the heart.
  8. Decrease in oxygen demand of the heart muscle.

The method of administration of the drug indicates how quickly it will begin to act on the body.When taken under the tongue, Nitroglycerin reveals the mechanism of action after 60 seconds, and its action lasts up to 5 hours in a row. Solution for injection enters the bloodstream most quickly. It works instantly and is used in an emergency to relieve a heart attack.

Special plasters, in the form of which the medication is produced, have a long-term effect on the human body. The dosage of the active substance directly depends on the size of the patch itself.

When can and when you can not take medication

Nitroglycerin helps from what? The answer to this question is in the instructions for the drug.A number of indications and contraindications are a mandatory item for study, even if the drug was prescribed by a specialist.

The drug should be taken in the following cases:

  • the presence of pain in the region of the heart;
  • recovery from a heart attack;
  • with the development of an acute heart attack;
  • if there is a diagnosis of stable angina pectoris;
  • left ventricular failure;
  • edema of the respiratory system;
  • reduced pressure;
  • thrombosis.

How to take the medicine and in what form, the specialist will tell you, since these parameters are determined on an individual basis. In addition to heart problems, the appointment of this medication is advisable in the case of pancreatitis, colic, disorders of the gastrointestinal tract (gastrointestinal tract) motility.

Cases when Nitroglycerin cannot be taken are also described in the instructions.

The medication is not used in the following cases:

  1. Hypersensitivity to the components of the drug.
  2. Simultaneous reception with other drugs of a certain pharmacological group.
  3. Severe hypotension.
  4. Genetic lactose intolerance.
  5. Hemotamponade of the heart.
  6. Adhesive pericarditis.

In addition, Nitroglycerin is a drug that can be taken, but with caution in the following cases:

  • in the presence of cerebral hemorrhage;
  • congestive heart failure;
  • iron deficiency;
  • increased thyroid function;
  • kidney disease;
  • liver disease;
  • Tendency to underpressure.

How to use the product correctly

Nitroglycerin instructions for use indicate general recommendations for taking the medication.

How to take Nitroglycerin correctly in a particular case, a specialist will tell, but general recommendations say the following:

  1. Alcohol solution is taken 2 drops under the tongue or sugar is moistened and kept until completely dissolved.
  2. Tablets should be placed under the tongue and kept until completely dissolved.

The maximum daily dose of an alcohol solution should not exceed 16 drops. The maximum number of tablets is 6 pieces. The dosed patch is kept for a certain amount of time, during which the optimal daily dosage enters the body.

Nitroglycerin dosage can be increased or decreased at the discretion of a specialist. You cannot change the dose on your own, as this can lead to negative consequences.

If poisoning with Nitroglycerin occurs, then as soon as possible after that, you should rinse the stomach and call an ambulance.Most often, cases of overdose are reflected in the work of the digestive tract, blood pressure, and the general condition of a person. The condition stabilizes when the drug is completely eliminated from the body.

Composition Nitroglycerin has a good, therefore, has a pronounced therapeutic effect. However, if the drug is used for a long period, then addiction can eventually occur. This leads to the fact that a person often begins to take pills, increase the dose, drink several pieces at a time. To prevent this from happening, people who use the medicine every day for quite a long time should only undergo treatment under the supervision of a specialist.

Nitroglycerin at high pressure

Can nitroglycerin at high pressure? People with this problem periodically experience bouts of hypertensive crisis. This is a sharp and strong increase in blood pressure, which is accompanied by severe throbbing pain in the head, nausea and vomiting, severe sweating, visual impairment, numbness of facial muscles. With an attack of a hypertensive crisis, urgent medical attention is needed, since such a condition is very dangerous and can lead to the development of a stroke.

A kind of ambulance for hypertensive crisis is nitroglycerin. It rapidly dilates blood vessels, due to which blood pressure begins to subside. This drug will be especially useful for people who, in addition to headaches, also feel pain in the heart during an attack. The only drawback of the drug is that after the attack has been removed, the patient may feel headaches, which are a side effect of the drug.

How to save a dog from poisoning

By reacting in time, you can save the dog.But the consequences of the presence of poison in the body can seriously harm health. Therefore, you must initially take all measures to prevent this sad situation:

  • Training is the main measure. Teach your dog not to pick up food, not to take it from strangers, eat only after the command. This is not an easy task. If necessary, consult an experienced dog handler.
  • The dog should walk only nearby. Never leave your dog alone outside. If a pet has a bad habit of running away, it should always have a muzzle on it for walks.This will prevent you from eating a poison-filled “treat”.
  • Communicate with local dog lovers, listen to the news – when reports of mass deaths of dogs, precautions should be increased to the maximum.

You should always have a first-aid kit prepared in advance with the following drugs in your arsenal:

  • Pyridoxine (vitamin B6) is an antidote to isoniazid.
  • Vikasol (vitamin K) – effectively stops bleeding in case of rat poisoning.
  • Sulfacamphocaine – restores heart function.
  • Heptral – supports liver function.
  • Absorbents – Polysorb, Enterosgel, activated carbon.
  • The simplest vomiting agents are coarse salt, soda, hydrogen peroxide.
  • Syringes of various capacities.

It is necessary to clearly study the basic rules of first aid, it is best to make a memo and put it next to the drugs in the first aid kit. All these actions will help protect the dog, and the first-aid kit is the main weapon for saving the dog’s life if trouble has already happened.

What to do if the patient still took the drug along with alcohol

First of all, you must understand the seriousness of the situation. Death in a poisoned person can occur at any moment. Call an ambulance immediately.

If a person is unconscious, he should be placed on a firm and level surface. Lift his legs, fix them in this position by placing some kind of roller under them.

Then you need to turn the victim’s head to one side .In this position, the risk of suffocation from a sunken tongue or vomit is minimal.

Before the arrival of a medical team from the ambulance, it is necessary to constantly monitor the presence of breathing and heartbeat in a poisoned person.

The pulse is most conveniently checked on the neck, where it is more pronounced. On the anterior-lateral cervical side, the carotid artery passes (on both sides). There, this large vessel is located almost under the skin, and even a weak heartbeat can be felt on it.

Breathing must also be checked correctly.The methods for applying a glass or mirror to the nose may be unreliable. It is best to put your hand on the patient’s chest, to cling to his chest with your ear. This way you can hear the breath and feel with your hand the raising and lowering of the chest as you inhale and exhale.

If you have recorded a cessation of cardiac activity and heartbeat, you must immediately proceed to resuscitation . And here your actions will depend on whether you provide assistance on your own or together with someone.

If you are alone, focus on chest compressions. If there are several “helpers”, add mouth-to-mouth artificial respiration to the intensive care unit. And periodically change with each other.

The basics of cardiopulmonary resuscitation are taught at school in high school in biology or OBZH lessons. If you no longer remember how to do chest compressions and mouth-to-mouth breathing, you can repeat this for yourself by finding information about these procedures in open sources.You never know what situations you will find yourself in.

Symptoms and causes of poisoning with validol

Poisoning with Validol is manifested by certain symptoms. At the initial stage of an overdose, there is a feeling of euphoria in the victim, increased excitement. In a similar situation, people can take the pills further. However, more serious symptoms gradually appear.


  • Feeling nauseous, urge to vomit,
  • Increased production of tears and saliva,
  • Fatigue, lethargy,
  • Desire for sleep,
  • Low blood pressure,
  • Head spin, discomfort,
  • heart,
  • Allergic manifestations on the upper layer of the epidermis,
  • Breathing problems,
  • Nasal congestion, vision problems,
  • Impaired consciousness,
  • Coma development.

Death is possible with a severe overdose, when a person uses more than ten tablets at a time. In such a situation, the respiratory process is suppressed, the person dies of suffocation.

“Nitroglycerin” – the mechanism of action

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

  1. Increase the flow of oxygen to the heart.
  2. Reduce heart rate and strength to reduce oxygen consumption.

Nitroglycerin is quite capable of doing all this. 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 decreases. Less work means less oxygen.

But the drug “Nitroglycerin” also increases the supply of oxygen to the heart due to the expansion of the coronary vessels, and this occurs more strongly in the place of ischemia, which leads to a rapid relief of an attack of angina pectoris.

The effect of taking the medicine can be seen within a few minutes. The expulsion of the drug from the blood occurs just as quickly. After 40-45 minutes, there will be no trace of him.

Adverse reactions to Nitroglycerin

Nitroglycerin can cause the following adverse reactions:

  • increased heart rate, drop in blood pressure, blue skin, rush of blood to the head;
  • headaches, vertigo, weakness, unreasonable anxiety, lethargy, problems with orientation;
  • visual impairment, exacerbation of angle-closure glaucoma;
  • dry mouth, abdominal pain, nausea, vomiting;
  • allergy, which is manifested by itching and rash;
  • decrease in body temperature;
  • hyperemia of the skin;
  • methemoglobinemia;
  • hot sensation.

To reduce the risk of developing adverse reactions, during treatment with Nitroglycerin, avoid staying in rooms with high temperatures: baths, saunas.

If after taking the drug there is a headache or migraine, then you can take Validol or drops with menthol under the tongue.

During therapy, it is necessary to refuse to drive a vehicle and work with potentially dangerous mechanisms.

Results of nitroglycerin overdose

Nitroglycerin overdose is extremely dangerous.The patient has:

  • a sharp drop in blood pressure;
  • loss of consciousness;
  • signs of respiratory failure;
  • nausea;
  • vomiting.

Cardiac arrest may occur if urgent measures are not taken!

If such symptoms occur, you need to lower the head end of the bed, provide oxygen access, inject the patient with the drug “Phenylephrine” and other vasoconstrictors.

It is recommended to carry out massive infusion therapy with saline solutions, dextrans, use of large doses of “Prednisolone” and “Dexamethasone”.A good effect can be obtained with the intravenous administration of ascorbic acid and cardioprotectors.

What is the maximum daily dose of Nitroglycerin

For Nitroglycerin, the maximum daily dose is 6 tablets. But it is important to remember that if the attack lasts more than 15 minutes, and three tablets taken at 5-10 minute intervals did not give an effect, then you must urgently call a doctor. This course of an attack is typical for a pre-infarction state.

What happens when nitroglycerin is combined with alcohol

Nitroglycerin itself causes headaches and dizziness. If you take it along with alcohol, such pain becomes very strong, almost unbearable .

When nitroglycerin is combined with alcohol, an immediate sharp drop in blood pressure occurs. Against the background of this condition, vascular collapse develops, a person may lose consciousness within a few minutes after taking the drug. At the same time, he falls into stupor or deep coma.

In this case, a poisoned person may spontaneously defecate and pass urine. Death occurs from cardiac arrest .

Methods used by doghunters

Hunters prepare various “snacks”, mix poison therein. These are minced meat cutlets, pieces of liver or liver sausage. Especially greedy poison is put into soaked bread sprinkled with sugar. The tablets are ground into powder or laid deeply whole, so that it is not visible.

Doghunters use three ways to feed the animal with poison:

  • Leave a “treat” in places where dogs are gathered – the most popular way, hunters mostly try not to advertise their personality.Food sprinkled with poison is laid out next to landfills, behind garages, near garbage cans. It can be scattered in parks, squares, even in specialized walking areas.
  • Approaching the flock, they throw baits from afar.
  • Those who are especially confident in their righteousness hand-feed the dogs.

Be always on the lookout. Knowing how doghunters poison dogs , noticing the symptoms of trouble in time, you can save the animal from death.

When medical attention is needed

In case of mild overdose and gradual disappearance of symptoms, it is allowed to carry out treatment at home after first aid.With more pronounced symptoms and a worsening patient’s condition, a visit to a medical facility is required.

Severe overdose is treated in the toxicology department. A visit to the hospital is obligatory for pregnant women and the elderly. Poisoning in children is dangerous if the baby is under three years old.

Treatment of an overdose includes a series of procedures that reduce the level of toxin in the body and restore the functionality of the systems.If necessary, resuscitation actions are carried out. The duration of treatment depends on the degree of overdose and the condition of the poisoned person.


This drug has an identical mechanism of action on blood vessels, since it contains nitroglycerin. The drug is available in many forms – tablets, capsules, ointments, aerosols, drops and patches. For a faster effect, it is better to use drops and aerosols, since they are very quickly absorbed into the blood.

The effect of the active substance begins within two minutes.

Side effects of Nitroglycerin and signs of poisoning with this drug

If the patient regularly takes Nitroglycerin during attacks of angina pectoris, an overdose is not something exceptional. Chronic patients safely take up to 3 – 4 tablets at the same time, and the maximum daily dose of the drug is 6 tablets. Experts recommend not to risk your health in vain! If 3 tablets of the drug do not bring relief, the patient should seek specialized help from a medical institution.

The use of Nitroglycerin for relief of an attack of angina pectoris can cause in the patient:

  • headache;
  • drop in blood pressure;
  • feeling of rush of blood to the upper half of the body;
  • tinnitus;
  • Sensation of heat and slight chills.

Similar manifestations of the action of the drug are possible with a slight excess of the recommended dose, and if there is a critical overdose of nitroglycerin, death occurs as a result of acute respiratory failure.

The most common victims of the drug are young children and the elderly. In the first case, the parents are to blame for leaving the medicine in an accessible place, and in the second – senile amnesia. In rare cases, nitroglycerin tablets are used for the purpose of suicide, however, such cases do occur.

In the annotations to the drug there is no clear definition of which dose of nitroglycerin will become lethal. For each patient, the negative effect of admission comes individually.The overdose can also be caused by the patient’s addiction to the medicine, caused by prolonged and haphazard use. The usual doses of the drug cease to provide relief, and the patient inadvertently exceeds the lethal dose of the drug.

Watch the video about why Nitroglycerin can not save, but kill:

Correct medication

Despite the great popularity of this drug, you must remember: this is still a medicine, so it must be taken according to certain rules.This is the only way to guarantee safety.

The most effective and quickest way to help is a “Nitroglycerin” tablet placed under the tongue. Since there are many blood vessels in the oral cavity, the medicine is almost instantly absorbed into the bloodstream, and relief comes.

If you decide to take a “Nitroglycerin” tablet, then it is better to sit down before that. Some may feel dizzy and, in exceptional cases, faint.

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 persists, 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 it is not far from myocardial infarction.

If your medicine cabinet contains “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 people manage to drip directly onto the tongue or even lick off the bottle cap.

Do 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.

Poorly tolerated “Nitroglycerin”

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

If at each reception you feel unwell, experience severe pain in the head, then it is worth discussing with the doctor the advisability 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 discussing the situation with your doctor.


“Nitrocor” is a drug containing the same active ingredients as nitroglycerin.That is why it also works quickly, helping to relieve an attack of angina pectoris. “Nitrocor” can also be used as a prophylactic agent.

The main application is under the tongue. In addition to the main components, the medicine contains sugar, dextrose and starch. It is not recommended to constantly use the drug, as it is addictive. You can take short breaks, thanks to which the body will again properly perceive the remedy.

What happens if you take Nitroglycerin to a healthy person

When a person with a healthy heart and blood vessels takes Nitroglycerin, then only side effects of the drug appear:

  • headache,
  • dizziness,
  • palpitations,
  • in the eyes,

  • nausea,
  • hot flashes.

In case of accidental use, it is necessary to drink more water with lemon juice, tea. It is recommended to lie down in a horizontal position to increase the pressure so that your feet are on a hill. If several tablets are taken at once (from 5 pieces), then gastric lavage and an ambulance call are required.

How doghunters poison dogs

To implement their intentions, hunters use inexpensive, readily available in all human pharmacies:


Used most often.This human-effective canine anti-TB drug is a deadly poison. Particularly sophisticated doghunters mix isoniazid with metoclopramide, an antiemetic. This is done so that there is no vomiting, and the death of the animal occurs faster.

  • Issue: in tablets, they can be bought without any problems at any pharmacy.
  • Action: The dog ate the bait with isoniazid – symptoms will begin to appear in 30-40 minutes.The animal becomes drowsy, there is a loss of coordination (legs give way, the animal drifts to the sides). After an hour and a half, the concentration of the drug in the body reaches a maximum – the dog vomits (often with blood), convulsions begin, breathing is depressed. Coma and death follow. Without immediate correct treatment, the dog dies in terrible agony in 3-5 hours from suffocation. The mortality rate from this poison is 100%.
  • What to do if a dog is poisoned: How to save an animal is described in detail in the article “What dose of isoniazid is fatal for a dog in case of poisoning.”First aid – urgently inject 5-6 ampoules of pyridoxine, induce vomiting, give an absorbent. Then urgently to the clinic.

Digitalis (digoxin)

The main active ingredient of the drug is Digoxin, one of the digitalis preparations. An effective cardiac glycoside that improves myocardial function. Overdose of digitalis leads to acute cardiac dysfunction and death, especially if the animal is actively moving.

  • Edition : white tablets.Sold without a prescription, are inexpensive.
  • Action : after this poison enters the dog’s body, there is general weakness, vomiting, increasing arrhythmia, leading to acute disturbances in the work of the heart and cardiac arrest.
  • What to do if your dog is poisoned : If you suspect digitalis poisoning, immediately induce vomiting. The animal has vomited – an absorbent should be given (Enterosgel, activated carbon). The sooner you get to the veterinary clinic, the better the chances of salvation.


Doghunters use atropine sulfate powder. It is mixed with minced meat and cutlets are made.

  • Issue: odorless white powder.
  • Action: Atropine acts on the central nervous system. The dog’s pupils dilate, it begins to bark hoarsely, and there is a strong thirst. Further, the pulse quickens, convulsions resembling epilepsy develop. Without urgent veterinary care, the animal’s basic reflexes fade away and a coma sets in.The dog dies after 6-12 hours.
  • What to do if your dog is poisoned: All you can do is to flush the stomach and give an absorbent. Further urgently to the veterinarian. Treatment for poisoning with this poison is symptomatic.

Rat poison of various composition

Used by dog ​​hunters relatively rarely, as it acts slowly and the animal has a chance of survival. With proper first aid and subsequent intensive treatment, the dog recovers completely.The main thing is to notice the alarming symptoms in time. The action of rat poison is based on its strong anticoagulant properties. Once in the body, it promotes blood thinning, damage to the walls of the capillaries – as a result, blood clotting is impaired, profuse bleeding occurs from everywhere. The dog dies from blood loss within a few days.

  • Issue: Doghunters use tablets or granules. Sold freely at the bazaar, in the shops “Garden-garden”, in household goods.
  • Action: The main symptoms are at first general weakness, pallor of mucous membranes, tachycardia, shortness of breath, refusal to eat, then bloody vomiting, bloody diarrhea, bleeding mucous membranes, without treatment – extensive internal bleeding (including the brain). How to quickly and effectively help your pet is described in the article “Symptoms of Poisoning in Dogs – First Aid”.
  • What to do in case of poisoning: Induce vomiting, give absorbents, inject 1-2 ampoules of Vikasol – then urgently go to the veterinarian.


Nitroglycerin and “Nitrosorbide” are drugs from the same class of drugs, however, there are slight differences between them. If nitroglycerin acts with lightning speed, dilating blood vessels and relieving the patient from an attack, then “Nitrosorbide” is slowly absorbed into the blood, affecting the vessels only after 2–2.5 hours. But this remedy stays in the body longer.

“Nitrosorbide” is suitable for situations where there are no sudden pressure surges and no ambulance is required.This drug is usually prescribed as a preventive measure.

After Nitroglycerin headache

If after Nitroglycerin you have a headache, it is recommended to dissolve 1-2 tablets of Validol. With constant pain syndrome, it is necessary to take nitrates with a prolonged release of the active substance (for example, Cardiket retard, Olikard retard) or drugs for angina pectoris of other groups. This helps to reduce the dose of Nitroglycerin sufficient to relieve heart pain.

If the tablet is much better after resorption, and part of it remains under the tongue, it is recommended to spit out the remainder.

Forms of preparation

“Nitroglycerin” can be attributed to those grandiose discoveries in the world of pharmacology that do not happen often. During its use, and this is more than 100 years, no more effective medicine for “angina pectoris” has been invented.

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

Nowadays, a 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 Nitroglycerin Aerosol. Despite the fact that all of these drugs contain the same substance, their cost can vary within a fairly wide range.

Interaction of Nitroglycerin and alcohol, Viagra

If the patient takes nitrates to relieve angina pectoris for a long time, the instinct for self-preservation gradually decreases, and the medicine no longer causes alertness. Some patients allow to use Nitroglycerin and alcohol together to enhance the effect of the drug, the consequences of this experiment in 100% of cases will be terrible.

Ethyl alcohol and its derivatives have a similar effect with nitrates and enhance the reaction of the human body to their intake.A decrease in blood pressure with the simultaneous use of alcohol and nitroglycerin becomes catastrophic and leads to the development of a coma.

This mixture has a negative effect on the patient’s liver. The medicine for stopping angina pectoris dilates the vessels of the gastrointestinal tract, and any alcohols destroy the liver parenchyma. Due to the increase in the diameter of the hepatic vessels, alcohol enters the hepatic tissue in large quantities, which leads to the development of cirrhosis and liver failure.

If you take Nitroglycerin and alcohol at the same time, the lethal dose of both substances is significantly reduced. For the development of a lethal complication, 5 – 6 tablets of a heart drug may be enough if the relief of an attack of angina pectoris was accompanied by the use of alcohol.

Many do not even know that Viagra was developed specifically to fight coronary heart disease. This drug has been widely used in hypertension, dilating the vessels of the periphery and lowering blood pressure.Currently, many well-known cardiologists continue to use it for various coronary disorders.

It should be borne in mind that the main users of Viagra are men 50-60 years old. It is this group and Nitroglycerin that he uses regularly. It should be understood that the simultaneous use of both drugs can lead to the development of a critical drop in blood pressure, heart rhythm disturbances and complete cardiac arrest.

As experts advise, the break between taking Viagra and Nitroglycerin should be at least 48 hours.Only in this case the possibility of complications from the interaction of these drugs will decrease to the usual clinical numbers.

Storage conditions

After purchasing any medicinal product, it must not only be taken in accordance with the instructions or recommendations of a doctor, but also stored under certain conditions. “Nitroglycerin” should not be exposed to light. Under its influence, 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 has prescribed “Nitroglycerin” (prescription in Latin), the instructions that come with it will be enough for you. There you can read about all storage requirements.

In the instructions, you can see a point 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 if all storage conditions are observed, cannot retain its medicinal qualities for a long time.Within a couple of months, its effectiveness will drop by 30%. In this respect, 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 bottle or a package 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.

“Dikor Long”

“Dikor Long” – organic nitrate, which is intended for a longer therapeutic effect. Basically, the drug is used after a heart attack during the rehabilitation period.

This remedy is not suitable for the treatment of seizures, as the effect occurs in about 30 minutes.

General signs of poisoning

Seeing that the dog picked up something from the ground while walking and ate it, carefully monitor the condition of the pet.The first signs of poisoning are as follows:

  • the dog is trembling;
  • vomits him;
  • saliva is profuse;
  • gait becomes wobbly, the dog shakes;
  • limb cramps are observed.

Drop everything, grab the dog and rush to the vet. Time passes not for hours, but for minutes.

How to recognize an overdose with validol

It is a mistake to believe that a violation of the recommended doses of the drug will not cause complications. One way or another, the body will react to a strong release of active substances, the drug.

Among the symptoms of overdose with validol are:

  • Hypotension;
  • Headache;
  • Nausea and vomiting;
  • Rapid heartbeat;
  • Profuse discharge of saliva and tears;
  • Dizziness and loss of consciousness.

An overdose of validol can be accompanied by a severe allergic reaction, up to anaphylactic shock and Quincke’s edema. A rash may appear on the victim’s body, and the skin may itch.

An allergic reaction to the drug can be recognized by the following signs:

  1. The appearance of a brown rash that itches a lot and quickly increases in size and spreads.
  2. Swelling of the face, larynx, extremities;
  3. Conjunctivitis;
  4. Sinus congestion;
  5. Shortness of breath;
  6. Dizziness;
  7. Weakness in muscles;
  8. Profuse cold and clammy sweat;
  9. A sharp decrease in blood pressure.

Why Validol overdose is dangerous

A severe allergic reaction is not the only consequence that can be encountered if a large dose of Validol is taken. Due to the large dose of the drug, a person will experience rapid vasodilation, which causes severe hypotension.

In addition, an overdose of validol can lead to a malfunction of the nervous system, which is fraught with malfunctions of the respiratory and cardiac systems.

Is it possible for a fatal outcome in case of overdose with validol? Yes, but only if these pills were taken during an angina attack.The fact is that with angina pectoris, a person does not give an account of his actions, and swallows validol one tablet after another in order to stop the pain, and this can cause myocardial infarction, in which death is possible.

The frequency of taking the drug

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

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

Most scientists who conduct research on this drug believe that constant use of it can lead to the opposite effect – an increase in the frequency of attacks and their severity.

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

The interaction of nitroglycerin and alcohol

People with cardiovascular diseases, suffering from angina pectoris, constantly carry nitroglycerin with them in the form of an aerosol or tablets. When a painful attack occurs in the chest, they know that it is worth taking a pill or spray it into the mouth, the pain syndrome disappears within 5-10 minutes .

If after taking nitroglycerin pain syndrome does not go away within 15 minutes, you should immediately call an ambulance.This phenomenon is typical for acute myocardial infarction, coronary syndrome.

But an attack of angina pectoris can occur during a feast, drinking alcohol. And the patient can, without hesitation, take the drug, not knowing that it is categorically contraindicated to combine nitroglycerin and alcohol.

The lethal dose of nitroglycerin drunk by a person in a state of alcoholic intoxication can be very small and insignificant, familiar to the patient.

So what should you do if an attack of chest pain caught a person who drank alcohol? It is necessary to immediately call an ambulance to such a patient, to explain to the doctors the seriousness of the situation.


  • https://otravlen.info/otravlenie-lekarstvami/peredozirovka-nitroglicerinom.html
  • http://fb.ru/article/259960/peredozirovka-nitroschlitserinom-posledst-pya-pertelnom doza
  • http: // mygipertoniya.ru / gipertoniya / chto-budet-esli-prinyat-nitroglitserin-zdorovomu-cheloveku /
  • https://www.syl.ru/article/303727/nitroglitserin-ot-chego-pomogaet-instruktsiya-po-primeneniyu-analogi- pobochnyie-deystviya
  • https://lifeo.ru/chem-travyat-sobak-doghantery/
  • https://otravlenye.ru/vidy/alko-i-narko/mozhno-li-sovmeshhat-nitroglitserin-s-alkogolem .html
  • https://otravlen.info/otravlenie-lekarstvami/peredozirovka-validolom.html
  • http://fb.ru/article/179446/nitroglitserin-ot-chego-pobochnoe-deystvie-nitroglitserina:
  • https://fb.ru/en/article/179446/nitroglitserin // otravilsya.com / himicheskie / lekarstvami / nitroglitserin /
  • http://CardioBook.ru/ne-vredno-li-pit-kazhdyj-den-nitroglicerin/
  • http://CardioBook.ru/nitroglicerin-smertelnaya-doza/
  • https://protoxin.ru/otravlenie/posledstviya-peredozirovki-validolom.html

Ischemia: causes, symptoms and effects

Ischemia – a local decrease in blood flow, due to which there is a temporary disruption or permanent damage to organs and tissues.

This article described the main causes and symptoms of ischemia, as well as the principles of treatment, so that you can understand the nature of the problem, consult a doctor in a timely manner and avoid complications.

According to the form of the disease, ischemia happens:

  • Sharp. It occurs with a sharp blockage of a large vessel, develops rapidly.

Additional vessels do not have time to connect to the blood circulation of the affected area, which can lead to a life-threatening situation. For example, a sudden heart attack or stroke.

There are also known cases when patients learned about a heart attack only when examining the heart, or when complications developed: arrhythmia, decreased contractility of the heart.

  • Chronic. It is formed gradually, as atherosclerotic plaques accumulate on the walls of blood vessels or with prolonged compression of the artery. Auxiliary vessels have time to activate to supply tissues, so the clinical manifestations of ischemia are not immediately diagnosed.

The danger lies in the fact that it drastically reduces the performance of organs.

For example, chronic ischemic heart disease can be complicated by rhythm disturbances and heart failure.Chronic ischemic brain disease leads to a weakening of thinking and memory.

Causes and symptoms

For reasons of occurrence and the nature of development, ischemia is divided into:

  • Coming due to prolonged compression of the artery leading to the organ. The cause may be a scar, swelling, foreign body, or accumulated fluid.

  • Arising from artery spasm. The reason may be the intake of vasoconstrictor drugs, a strong emotional or physical shock: panic, painful shock, hypothermia, mechanical irritation.

  • Occurring due to partial or complete occlusion of an artery by a thrombus, embolus. Also, the closure of the lumen is possible due to vascular diseases: atherosclerosis, obliterating endarteritis, nodular periarteritis.

Also, ischemia can develop with trauma – due to mechanical rupture of blood vessels or blood loss, as well as due to blood diseases – an increase in its viscosity.

Any form of the disease is characterized by a violation of the normal functioning of organs – a slowdown in blood flow and a violation of metabolic processes, sometimes very severe.Symptoms in the affected area include:

  • dystrophic changes and decreased tissue elasticity;

  • lowering temperature and blood pressure – for the limbs;

  • numbness, tingling and pain.

If you experience these symptoms, we strongly recommend that you see a doctor immediately.

But chronic heart ischemia may not manifest itself clinically, while remaining very dangerous.The appearance of the first symptoms may indicate a far-reaching process. They are:

  • Pain behind the sternum that worsens with exercise and may subside with continued exercise.

  • Shortness of breath and a feeling of interruptions in the heart. When these symptoms appear, it is necessary to consult a doctor as soon as possible, and if an attack of pain occurs for the first time or its nature is unusual, then it is necessary to immediately take nitroglycerin and call an ambulance.

It is currently possible to help a person in any situation and at any stage of the disease. Although, of course, the effectiveness of this help and the prognosis are significantly better if the visit to the doctor took place in the early stages.

The doctor can identify ischemia or the risks of its manifestation at the initial stages of the development of the disease. For this, a detailed analysis of risk factors and exercise tests are used: treadmill test, bicycle ergometry, stress echocardiography. As well as a study of blood vessels: coronary angiography, multispiral computed tomography and ultrasound method are the most affordable, recommended as a screening or first-line study.


The consequences of ischemia depend on external factors, the extent of the disease and the general condition of the body. These include:

  • Duration of ischemia and oxygen starvation of the affected area – hypoxia.

The process of dying off of myocardial tissue develops within 12-18 hours from the moment of arterial damage.

With a complete restriction of blood access to the extremities – after 1.5-2 hours, this may be due to a complete rupture of blood vessels, for example.

  • Localization – organs and tissues have different sensitivity to oxygen starvation. Organs of the cardiovascular and nervous systems are most sensitive to hypoxia.

  • Diameter of the affected arterial vessel – blockage of large arteries entails more extensive necrotic tissue lesions than smaller vessels.

  • Development in the affected organ of the system of auxiliary vessels for additional blood access – collateral circulation.

For example, the lungs and limbs have an absolutely sufficient presence of auxiliary blood vessels, which helps in a short time to provide the affected area with the necessary amount of blood, and with it oxygen and nutrients.

Organs with absolutely insufficient collateral circulation include the heart, brain, kidneys and spleen. The total diameter of the vessels and capillaries in them is less than the diameter of the main artery – with complete or significant blockage of the artery, the blood flows in critically insufficient volume or stops altogether.This can lead to heart attack, tissue necrosis, or death.

The general consequences are: the development of oxygen starvation and impaired delivery of nutrients – damage to cells and changes in the properties of the ischemic area.

Based on the structure of the body, the organs of the nervous system and the cardiovascular system are most susceptible to ischemia. Unfortunately, the performance of these particular organs is critically important for the life and normal functioning of the body.

If ischemia is so pronounced that part of the cells and tissues of the affected organ dies, a heart attack develops. In the case of heart damage, they speak of myocardial infarction, in the case of brain damage, the term “ischemic stroke” is often used.

To form a competent treatment program, it is necessary to determine the nature of the origin of the disease, the duration and extent of the lesion. The general steps in treatment are:

  • dilation of arteries and elimination of spasm,

  • development of the functionality of auxiliary vessels,

  • correction of cholesterol level,

  • elimination of atherosclerotic plaques,

  • reduction of blood viscosity and prevention of thrombus formation,

  • correction of metabolism in the affected tissues and increasing their resistance to hypoxia.

Treatment of ischemia can be either therapeutic or surgical. Currently, doctors have a fairly wide range of possibilities in their arsenal: drugs and types of surgical interventions.

Doctors of the Chernaya Rechka Cardiology Center specialize in the treatment of coronary heart disease and the rehabilitation of cardiac patients.

Lee Iacocca “Manager’s Career”

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