To much Nitroglycerin

Hi! I have so much chest pain. There is very rare day that I do not have chest pain that requires Nitroglycerin. I asked my cardiologist if you can be addicted and he said no. I am currently wearing 2 patches, taking a nitrate and still have to pop an occasional extra pill. I know that I have built up a tolerance but every time I try to decrease my Nitro the pain escalates.
I don't know what I can do to decrease my tolerance. Last time I tried, with Dr. approval, I ended up admitted with chest pain and a Nitro drip. That's when he put me on 2 patches so I could go home again. I'm just very frustrated and frightened because I don't know where I can go from here. Any suggestions. I do have documented vasospastic angina.

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Hi interestingcase!

I do understand your frustration... I've had vasospastic angina for 28 years (I'm 51 now) and, many years ago, developed nitrate tolerance. My cardiologist didn't let it get as extreme as yours before trying something new. Are you currently taking a calcium channel blocker? These are considered the "gold standard" for treating arterial spasm. I was on a combination of oral nitrates and CCB's for several years and gradually withdrawn from the nitrates. Now I only use sublingual nitro a couple times a week or less. I would seriously check into the CCB's if you're not already on one. Good luck and I hope you get some relief soon!

Terri

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Thanks, I am on 2 Calcium ChannelBlockers. I had been on one since the beginning. When I went to IU Med Center they took me off. That lasted about a week. Since July of 2008 he added Ranexa which is a second CCB. I've tried all of them I think but still have to take so much nitro. Since he increased my patch to 2- 0.6mgs it has helped but I still break through and need 2-3 a day sometimes more sometimes less. I just don't know how much can I take. Each time I increase and then I break through taking more than 5-6. I went into the hospital last Sept and while I was there I took double digit pills with a single patch. I really just want to feel good and continue my life.

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Well, your name, interesting case, is certainly true. I have to add my 2 cents worth. I assume that you have your cholesterol under control and don't smoke. That is so disconcerting to need that much extra nitro. Have you tried any relaxation techniques or drugs for anxiety or anything like that? I think that stress is my trigger for spasms, then there is cold, perhaps allergies and maybe some unknow triggers. Do you have any food allergies? Have you heard of L'arginine supplement. Some have found this to help. Ask your doctor about it.
So sorry you are having these troubles. I think the Cleveland Clinic is supposed to be one of the best places, so not sure where you go from here. Joyce

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Also, are your levels of magnesium OK? Some think that magnesium helps.

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"I am currently wearing 2 patches, taking a nitrate and still have to pop an occasional extra pill. "

'If it works, it isn't broken so there's no use for a fix.' I asked my doctor if I could discontinue some of my medication and that's what he told me. I, too am sick of taking all this stuff. But it worked for almost 10 years and I'm still alive.

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Thanks for all the replies. I take L-Argininge and just added Magnesium to my drug supply. I am glad to hear from others who cannot kick the Nitro. At times I still feel crazy. How can a person be on so much medicine and still spasm. Today at cardiac rehab I had to cut down on what I was doing. I strated and ended with a nitro. I know I have certain triggers,caffeine, chocolate( I can have a bite or two), cold weather changes, sometimes exertion and crazy as it sounds, it hurts to sing and sometimes it hurts becauses it can. I use prayer, meditation visualization and music to help as well. For those using alot do you have any trouble at work.I am a nurse and we decided that stress was part of the factor in my spasm so I have been on disability for 13 months.I want to go back to work but am afraid that I will not be able to do it and then have to start over on the disability process.

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I get spasms when I breathe sometimes. It's annoying. Doc said nothing about it.

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It is very frustrating. Yesterday I needed an additional 7 nitros to get throught the day. I take that along with Darvocet and Ativan. Plus I just plan sat yesterday. Now I also took a nap and did some hand quilting. Today no matter what I do its causing chest pain. I got dressed, made my bed, did a little cleaning, nothing earth shattering.
I see the Doc on Monday and need to ask if my stents are okay. I don't have EKG changes or enzyme changes just pain so far. Although that was the case last year and when he cathed me I had a narrowing below the first stent and got a second stent then. Still the only tests it show up on are perfusion tests and caths.
I don't know what to do. I would really like to get back to work but I don't think I would hire myself- too much chance of sick time. Thanks for letting me know I'm not alone and not crazy.
Joan

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Have you ever been checked for GERD? Just a thought...

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I am the same nitro all day ,every day recently, with little relief from pain. It is so frustrating that EKG wont show anything. I am allergic to isotope in nuclear scans. I dont know if there is any point asking Dr for stress test. I feel like I am going round in circles.

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Geez Joan that must be frustrating. I knock wood do not suffer from Angina, I have nothing to add but caring prayers that you find some relief & freedom from what appears to be holding you hostage.

Heart Sister Denise

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Thanks for all the replies. Hany I do have GERD and am being treated for it. When I have the pain and pressure I try antacids. There is a different feeling between heart related and GERD. I have drank so many GI Cocktails, My Doc gives them to me about every time I go to the hospital.I think one time I had about 4 in one day. The only thing it does for me is make my tongue numb, it doesn't relieve the pain. This morning I have been miserable I have taken 4 Nitros, 4 tums,, Darvocet and Ativan. I am fine as long as I do not do anything, It's annoying. I feel different when it is chest pain, I'm foggy, they pain is in my chest, back, neck and lt shoulder, the pressure, it feels like a large dog is on my chest sometimes an ox, and nitro and rest was the only way to get rid of it. I have been like this for 4 days.
Tomorrow I go to see my cardiologist. I feel something has changed but its only been three weeks since I was in the hospital. I don't know if there is anything to do but I'll see tomorrow. At the beginning of this with the persistance of symptoms, I probably would have gone to the ER now, I wait until it gets unbearable.

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Hi Interestingcase, one thing that stands out to me in your last post is that you get relief from resting. If you were having spasms I'd think that resting would make no difference. I'm glad you are seeing your cardiologist today. It sounds as if you need him/her. In my case, after getting stents placed, I kept developing scar tissue that required another stent. I now have a total of nine stents. You could be having a blockage. Good luck!!!

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Hi interestingcase! I had the same question as CarolSue did - about GERD. Nitro is a vasodilator, so it works not only on cardiac tissues, but also on all tissues including those of the GI tract. Can provide relief of GERD, in other words.

Q: Is 'vasospastic angina' the same thing as Prinzmetal's angina? If it is, PM spasms often occur while at rest, as Penny mentions above, so are not relieved by rest, unlike cardiac blockages that cause symptoms on exertion, relieved by rest.

How did you cardiologist's appointment go? Hope you got some important answers to this frustrating situation!

XOXOXO


http://www.myheartsisters.org

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Thanks for all the replies. I do have GERDand have been tested for esophageal spasms- it was negative. There is a difference between my GERD symptoms and Heart symptoms. The pain and/or pressure is just different. Many times my cardiologist has given me meds to see if it is the GERD acting up. I got a numb tongue and no relief from the pain and pressure. I've been scoped a couple of times and see my GI Doctor regularly and of course I am on meds to help with the GERD symptoms. When GERD is at its worst I feel like fire is shooting up my esophagus along with nausea etc..
I did see my cardiologist on Monday and he did an EKG and Echo- Both were okay except for the EKG showed prolonged QT but both cardizem and Ranexa will cause that.
I also had a heart cath yesterday no blockages just the spasm as usual. I'm happy but not.
If he would heve found something and fixed it maybe my quality of life would improve. My sister told me it is just like her back pain and I have to just live with it. I know I have to live with it.I have for 4 years. But last thing I heard is that back pain wouldn't kill you -vasospsam in the LAD can. But I know she means well and wants me to get better, she just doesn't understand how that comment makes me feel. I already feel like a hypochondriac some days. When people ask me how I am I just say good - many don't really want to know anyway. The ones who do, I answer honestly - some days great and some days crappy.
Sorry I am just a little bummed. I think if I had a good cry it would help- but that's hard for me to do. Tomorrow I see my counselor- hopefully it will help.
My brother the cardiologist wants someone in his group to look at my case. He has a friend who is very interested. So I'm going through it. I just want to make sure that Ed(my cardiologist) doesn't think I don't trust him. He has been with me and believed me when others have not. I know that I would have had a big MI by now if he had not. Ed always talks with my brother and lets him in on the caths. I'm sure he will be okay. Any changes the other Dr. wants will still have to go through him. I've been down that road before when I thought they were communicating and they were not and then Ed had to put things back together when I got in trouble because the other guy was too far away.

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I am new to this group, it's the first I feel like I am with people who knows how I feel and I feel at liberty to share my feelings as to what I am going through.

Now to your nitro problems I have the same problems constant angina pains and then the Nitroquick works but it will end up dropping your pressure so low then it's pass out time. My Cardiologist have now prescribed Ranexa I guest the dosage goes accordingly.
I am just sharing a little of what I am going through, the angina pains is not awful as before still have the pain with any form exertion and i still do use the nitroquick but not as much, and what I learned is the less exertion the less pain.
Hope this will be helpful to you.

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Usually when I rest I rest with Nitro. For instance when I go to bed and cannot sleep because of the pain I usually take a cocktail of nitro, ativan and darvocet. Usually more than 1 nitro. When I rest after doing something that I guess is strenuous( Used to not be), I have to rest so that I do not take multiple nitro.
If rest alone takes care of it, it is usually a long rest like 30-60 minutes.
The spasm is documented. As is GERD. I have both. There still is a difference in the pain. Nitro takes one away and tums or rolaids help with the other.

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