How does nitroglycerin decrease the level of chest pain that a patient experiences?

Find diet, exercise, and other strategies to help prevent and manage coronary artery disease in the Prevention section. 

In addition to lifestyle measures, your healthcare provider may decide that medications or surgery are necessary to treat your condition. 

Medications

Ask your healthcare provider about the possible side effects of the medications prescribed, and be sure to let them know if you experience side effects. But don’t stop taking your medications without talking to your healthcare provider first. This could worsen your condition, and certain medications are dangerous if stopped suddenly. 

Blood Thinners

Blood thinners (antiplatelet and anticoagulation drugs) help prevent blood clots. 

• Aspirin is a key drug for treating coronary artery disease. The dosage varies from one “baby” aspirin (81 mg) to one regular-strength (325 mg) tablet per day, depending on your condition. Potential side effects include stomach upset, ulcers, and bleeding problems. Though coated aspirin helps prevent stomach problems, also make sure to keep uncoated, full-strength aspirin tablets on hand in the event of a heart attack. 
• Other common antiplatelet drugs commonly used for heart disease include clopidogrel (Plavix) and prasugrel (Effient). 
• It is important to note that there are anticoagulant medications that include warfarin (Coumadin), and the newer oral anticoagulants: rivaroxaban (Xarelto), dabigatran (Pradaxa), and apixaban (Eliquis). These medications work in a different mechanism to thin the blood and prevent blood clots. They may be prescribed in addition to aspirin or anti-platelet drugs, depending on your underlying health conditions. It is very important that you take these medications exactly as prescribed by your healthcare provider, and not to stop or skip doses. Missing even one dose puts you at risk for developing clots.

Nitroglycerin

Nitroglycerin relaxes and widens blood vessels to your heart so that more blood can flow to the heart muscle. This helps relieve chest pain and makes breathing easier. Nitroglycerin tablets are usually placed under your tongue so that the drug passes into your bloodstream quickly.  Since fainting and headaches are possible side effects, it’s best to sit down before taking nitroglycerin. Nitroglycerin also comes in a cream, in a patch, or an aerosol spray.  Several prescription and over-the-counter medications can interact with nitroglycerin in a dangerous manner, dropping your blood pressure to unsafe levels. It is very important that your provider knows everything that you are taking, no matter how “harmless’ you think they are.  

Blood Pressure Medications

Treating high blood pressure can ease angina pain and decrease your risk of heart attack and other conditions, such as stroke and kidney disease. Generally, blood pressure is treated if it is higher than 140/90 mmHg, but lower targets may be necessary in people with diabetes, chronic kidney disease, or other chronic health conditions. The optimal blood pressure for an older adult is a decision best discussed with a healthcare provider as it depends on underlying health and health conditions. A particular class of blood pressure medications known as "beta blockers" is especially helpful in people with coronary artery disease.  

Cholesterol-modifying Drugs

Several medications can raise the level of “good” HDL cholesterol and lower the level of “bad” LDL cholesterol in your blood. This helps prevent plaque buildup in your coronary arteries and is especially important right after a heart attack.

• Statins block a substance that your liver uses to make cholesterol. Common statins include atorvastatin (Lipitor), lovastatin (Mevacor), rosuvastatin (Crestor), and simvastatin (Zocor). Ask your provider about prescribing a generic form, which is less expensive and equally as effective.
• Niacin (vitamin B-3 or nicotinic acid) helps raise your “good” HDL cholesterol and lower “bad” LDL cholesterol. Niacin can cause itching, redness, or a tingling feeling under your skin. To minimize these effects, do not drink alcohol or hot beverages shortly after you take niacin. Once your body is used to niacin, these effects usually go away. However, it is important that you do not miss any doses, as missing even one or two doses can bring back the side effects mentioned above.
• Fibric acid or "fibrates" are used when triglycerides are high in addition to high "bad" LDL cholesterol. 

Surgery

Severely narrowed coronary arteries may require surgery to prevent a heart attack. 

Angioplasty and Stent Placement (also known as percutaneous coronary intervention, or PCI)

In this procedure, your doctor will thread a tiny collapsed “balloon” through a very thin tube into your damaged coronary artery. When the balloon inflates, it opens the blockage. A small stent (a wire mesh cloth) is often left inside the artery to help keep it open. Some stents contain a slow-releasing medication that also helps keep the artery open. 

Coronary Bypass Surgery

In this surgery, a new artery is connected (grafted) to the blocked artery, from a point just before the blockage to just after it. This allows the blood to bypass the blockage. The graft is often a vein taken from another part of your body. Since this procedure requires open-heart surgery, your doctor usually recommends it only when multiple coronary arteries are blocked. 

Often, bypass surgery is associated with postoperative cognitive impairment (some aspects of memory are affected) and functional decline (loss of independence in taking care of yourself). In many cases, the return to preoperative abilities can take several months. To minimize loss of independence, rehabilitation should be started in the hospital as soon as possible after surgery. Whenever possible, patients should participate in a structured cardiac rehabilitation program after leaving the hospital. 

Complications of Coronary Artery Disease 

Chronic Stable Angina

If you have coronary artery disease, you may experience chest pain, or angina, that occurs in situations when the heart muscle requires more oxygen. 

The causes of stable angina usually include:

• Strenuous physical activity
• Large meals
• Cold weather
• Severe emotional stress

If you have stable angina, you’ll begin to recognize the things that bring on chest pain, and you can modify your activities accordingly. For example, usually as soon as you slow down or stop exercising, your chest pain will improve and eventually go away.  

Angina pain usually does not last more than a few minutes, and it is relieved by taking nitroglycerin or another medication. 

If you have chronic stable angina, you should notify your doctor if you:

• Have angina symptoms more frequently
• Have angina when you are at rest
• Feel tired more often
• Feel dizzy or faint
• Feel like your heart is skipping beats, or is beating very slowly or very fast

Call 911 if your angina pain:
- Becomes stronger
- Does not go away after 15 minutes
- Does not go away after three doses of nitroglycerin
- Comes back after first being relieved by nitroglycerin 

These may be signs of a heart attack.

Heart Attack (also called myocardial infarction, or MI)

(Also see Heart Attack information in the Causes and Symptoms section.)

If you think you are having a heart attack, call 911 immediately. The first minutes to hours after a heart attack are critical to your survival, so don’t delay. Getting treatment early can greatly decrease the damage to your heart muscle and improve your chances of recovery. 

While you’re waiting for the ambulance, chew a non-coated, full-strength (325 mg) aspirin tablet, or 3 baby aspirin.  This helps thin the blood and prevent clots.  Be sure to tell the doctor in the emergency room that you have already taken aspirin so you don't receive another dose.

An emergency room doctor can inject you with “clot-busting” drugs to break up any blood clots during or shortly after a heart attack.

Because of improved treatment and better public awareness of heart attack symptoms, most people survive heart attacks and are able to live full and normal lives after receiving treatment and rehabilitation. 

Cardiac Rehabilitation

Cardiac rehabilitation programs improve people's exercise capacity, physical function, and quality of life, as well as help reduce anxiety. A rehabilitation program is either inpatient or home-based. The program typically includes an individualized, medically supervised exercise program. Survival rates are higher for patients who have rehabilitation compared with those who don’t, and better participation leads to better outcomes. Medicare provides for up to 36 sessions after a heart attack, angioplasty, or bypass surgery.

Heart Attacks in Women

Women can experience the signs of a heart attack differently than men. While chest pain is still the most common symptom, it may be milder or may not be present at all.

Women are more likely to have pain in the jaw or back or have some of the other symptoms, particularly shortness of breath, nausea and vomiting, or even anxiety.

Most heart attacks in women occur after menopause. Menopause increases the risk in older women because of a loss of estrogen, which is followed by an increase in “bad” LDL cholesterol levels.

Last Updated July 2020

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