Angina and GTN spray

If you've been diagnosed with angina, you've probably been given a GTN (glyceryl trinitrate) spray or tablets. This page is the plan to follow when the pain comes on, and the exact point at which it stops being angina and becomes a 999 call.

The angina action plan

Stop what you're doing and sit down. Rest. Don't try to "walk it off". If you're driving, pull over safely and stop.
Use your GTN spray or tablet. One or two sprays under the tongue, or one tablet under the tongue. Sit down first: GTN can make you light-headed.
Wait 5 minutes. If the pain has gone, rest a while longer before carrying on. You don't need to call anyone, but tell your GP or nurse if it's happening more often.
Still got pain after 5 minutes? Take a second dose. Same as before.
Still got pain 5 minutes after the second dose? Call 999. Say you have angina and your GTN hasn't worked. Chew a 300mg aspirin if you have one and you're not already told not to. Don't take a third dose while waiting unless the crew tells you to.

Don't wait the full 10 minutes if:

the pain is much worse than your usual angina
it came on at rest, or woke you from sleep
you're sweating, sick, breathless or faint
you feel that something is seriously wrong

Call 999 straight away.

Stable vs unstable angina

Stable angina

Predictable: comes on with the same amount of effort each time
Triggered by exertion, stress, cold, big meals
Eases within a few minutes of rest or GTN
Same pattern for weeks or months

Manage with your plan. Tell your GP if it changes.

Unstable angina

New angina that's severe from the start
Coming on with less effort than before, or at rest
Lasting longer, happening more often
Not responding to GTN as it used to

This is a medical emergency. It's often the warning before a heart attack. Call 999.

Using GTN properly

Carry it everywhere. A spray in a drawer at home is no use in the supermarket car park.
Sit down before using it. It drops your blood pressure and can make you dizzy or faint.
Spray under the tongue, then close your mouth. Don't inhale it or swallow it.
Headache and flushing are normal and mean it's working. They pass in a few minutes.
Check the expiry date. Sprays usually last 2 to 3 years. Tablets go off 8 weeks after opening: write the date on the bottle.
You can use it before activity you know brings on angina, such as climbing a hill or going out in the cold.
Never use GTN with erectile dysfunction tablets (sildenafil/Viagra, tadalafil/Cialis and similar) within 24 to 48 hours. Together they can cause a dangerous drop in blood pressure. If you've taken one and get chest pain, tell the 999 crew.

Getting angina less often

Angina is a sign that your heart arteries are narrowed. The things that reduce your risk of a heart attack are the same things that reduce the frequency of angina: not smoking, taking the medicines you've been prescribed every day (usually aspirin, a statin, and something like a beta blocker), keeping blood pressure and cholesterol down, and staying active within your limits. Cardiac rehab programmes accept people with angina, not just those who've had a heart attack. Ask your GP.

Keep a simple diary: when the angina happens, what you were doing, how many sprays, how long it lasted. Bring it to your GP or cardiology review. A change in the pattern is the most useful thing you can tell them.