Can Nitroglycerin cause death?

Diseases of the cardiovascular system are in first place in terms of the number of deaths.

There are three reasons here:

• The key is the lack of attention to one’s own health. This is especially typical for the post-Soviet space with a low level of medical culture among the population.
• The second is the low-symptomatic nature of the pathologies, which does not allow for a timely response.
• The third is the unqualified actions of doctors or the inattention of the patient himself. This reason concerns poor-quality first aid and improper use of medications.

The further development of the pathological process and the prospects for recovery depend on qualified measures.

Nitroglycerin is a means of initial, emergency care for diseases of the cardiovascular system. It is mainly considered as a pharmaceutical drug for heart pain to relieve discomfort, which is only true to some extent. In fact, the clinical effect is much broader.

It is strictly forbidden to use the product without the recommendation of a treating specialist, because there are many nuances: contraindications, precautions.

Composition and release forms

The drug exists in several forms. Each is used in a certain group of clinical situations; the question is not so obvious at first glance; it is impossible to draw conclusions when reading the instructions. This point should be considered in more detail.

• Solutions. On water, oil and alcohol. The first is used for injection, so it makes sense to prescribe it in urgent cases.

It operates for a short period of time, ideal for providing emergency assistance on site or in the intensive care unit during intensive care.

• Tablets and capsules. There are forms with a short action and a prolonged effect that lasts for many hours. The choice depends on the goals of therapy.

Nitroglycerin is not always prescribed to relieve an emergency condition.

It can be taken over a long period of time, as part of the treatment of dysfunctional disorders, coronary heart disease, and during the rehabilitation period after a heart attack.

• Patch. It also has a long-lasting effect on the body.
• Ointment. Used relatively rarely. Almost never for cardiovascular diseases, because this form has a local effect.

Strictly speaking, Nitroglycerin is used not only in the treatment of heart and vascular diseases. But also with some other abnormalities in the functioning of the body (see below).

• Aerosol.

The specific form of release depends on the needs and goals of the therapeutic course.

Short-acting products are good for emergency use.

The prolonged type is widely used in the treatment of chronic disorders, within the framework of many months of use.

As for the composition, the name refers to organic nitrates. As the name of the group of compounds suggests, these are nitrogen-based substances. In this case, its oxide.

The pharmacological effect is to relax and dilate blood vessels, mainly veins, thereby normalizing local blood flow. The quality of respiration and cellular nutrition directly depends on this.

Effect of Nitroglycerin on the heart

When dilating the vessels of the peripheral part with the help of injection into the artery, it can reduce the load on the blood flow system and the cardiac organ.

The reduced presence of biological fluid through the relaxed hollow arteries reduces the pressure in the veins, in the right-sided chambers of the heart organ, as well as in the pulmonary circulation of the bloodstream. Very often, Nitroglycerin is used as an emergency aid for swelling of the lungs.

With less load on the heart muscle, with lower pressure in the chambers of the organ, the myocardium’s need for oxygen becomes less, which is why the analgesic effect occurs during an attack of angina.
The vasodilating effect of nitroglycerin helps to cope with many heart attacks, but at the same time this medicine has a plugging effect on the arteries of the brain:

• Headache,
• Head spinning
• Loss of consciousness, fainting.

When using prolonged types of the drug for a long period of time, drug resistance may develop in the body and the effectiveness of the drug is significantly reduced.

The doctor's recommendation is not to use the drug more than 2 times a day.

Indications for use and dosage

There are many reasons for the use of Nitroglycerin, which determines its widespread use in the practice of cardiologists and specialists in some other profiles.

• Angina pectoris. A type of coronary insufficiency when blood flows to the heart in a small volume due to stenosis (narrowing) of the arteries through which it moves. Nitroglycerin for angina is used in tablets in an amount of 1-2 with an interval of at least 10-20 minutes. Or 4-6 drops in solution. Injection is practiced only by doctors, so there is no point in knowing the dosage.
• Chronic heart failure. Allows you to partially normalize the trophism (nutrition) of tissues. Not suitable for long-term use, because clinical effectiveness is not always sufficient, but the risks of side effects remain high. The issue is decided at the discretion of the doctor. Form of application: tablets or capsules of prolonged action. It is enough to drink 1-2 tablets a day.
• Heart attack. If Nitroglycerin is almost always used for heart attacks, and helps well, for a heart attack the task is much more difficult, depending on the cause and form of tissue necrosis of the muscular organ, a complete ban on the use of nitrates is possible.

In some situations, this will provoke even greater tissue ischemia and rapid death of cardiomyocyte cells.

Use is permissible only with the permission of the treating specialist. Mainly in the form of an injection solution.

Patients take 1-2 tablets at their own risk. The scheme is approximately the same as for angina pectoris.

• Pulmonary edema, cardiac asthma attack. Used for emergency purposes. The maximum permissible number of tablets in this case is 3-4, drops - no more than 16. The volume of use depends on the condition of the patient, the pathological process that provoked the dangerous disorder.

There are other diseases that may warrant the use of the name.

The effect of Nitroglycerin occurs within 3-7 minutes, regardless of the form, which makes the drug flexible and versatile.

• Spasms of cerebral vessels. Including migraines, although this is not a direct indication. In this case, 1 tablet in the acute phase is enough to partially or completely restore the patient’s normal condition.
• Violation of uterine muscle tone. It can be extremely uncomfortable, so Nitroglycerin is used to relieve the unpleasant sensation. This is not an end in itself. You can act in this way in acute cases, but then you still need to consult a doctor to determine the cause of the deviation.
• Painful spasms of organs and structures of the excretory system: ureters, kidneys and others. As part of therapy or in the event that classical medications like Drotaverine, No-shpa and others similar in the group (antispasmodics) do not help.
• Irritable bowel syndrome, colitis. All conditions that provoke a spontaneous increase in the tone of the muscles of the digestive organs. It is used for a short time and only to correct discomfort.
• Asthmatic attack of non-cardiac origin. Due to an allergic reaction or infection. It makes sense to take the drug only in extreme cases, if the effect of glucocorticoids and bronchodilators is delayed or incomplete.
• Gallbladder problems. Including stagnation of secretions, the so-called cholestasis. Happens quite often.

In the described cases, when cardiac structures are not involved, it is difficult to name a universal or even approximate dosage. There are too many factors to consider. This is a strictly individual task.

Long lasting nitrates

For prophylaxis, nitrates are prescribed as a long-acting tablet. Long-acting medications are also prescribed when angina attacks occur regularly.

Take the tablets before eating and wash them down with plenty of water (up to 200 milliliters). Take 0.5 tablets 4 times a day.

For the treatment of angina attacks, the dosage is 1 tablet at least 3 times per day.

Long-acting drugs from the nitrate group act slowly and therefore accumulate in the liver tissues. During an attack, the maximum dosage of prolonged Nitroglycerin is no more than 2 tablets.

How Nitroglycerin works for various conditions

Angina pectoris

Acute coronary syndrome, which causes a lot of discomfort without destruction of the muscular layer of the heart, which can be easily relieved with Nitroglycerin.

It is perhaps the main medicine for stopping the clinic and restoring the patient’s normal condition.

The pharmaceutical agent affects veins and small peripheral capillary vessels, but practically does not affect arteries.

Thanks to this paradoxical effect, nutrition and cellular respiration return to normal. The contraction frequency drops, but the pumping function does not suffer.

The effect of Nitroglycerin on the heart is to restore trophism (nutrition), blood flow, relieve pain, an attack of fear and shortness of breath.

Attention:

The medication does not affect the root cause of the disorder. You cannot do without consulting a cardiologist in the future. Treatment is required, not just relief from the main symptoms.

Myocardial infarction

Acute tissue necrosis affects the general condition of the patient. The risk of death increases in proportion to the time of inactivity.

It is based on a group of processes: narrowing of the coronary arteries, heart rhythm disturbances. It is these symptoms that Nitroglycerin relieves. Partially or completely depends on the aggressiveness of the process.

In addition, the drug reduces the need for oxygen in the muscle organ due to a complex biochemical mechanism.

Thus, Nitroglycerin helps relieve pain, shortness of breath, high blood pressure and other issues. However, all of the above is only partially true.

Some forms of heart attack, on the contrary, prevent the use of the drug. It is difficult to determine in advance what type of pathological process is taking place in a particular case without diagnosis.

For example, doctors do not recommend using the drug for extensive myocardial infarction. Therefore, the indication is quite controversial, there are risks.

Chronic heart failure

Accompanied by a decrease in the contractile, pumping function of the heart, which affects the condition of all organs and systems.

Because the amount of oxygen and nutrients supplied to the brain, kidneys and the muscle organ itself is small, and then reaches critically low values.

The basis of the pharmacological action in this case is the ability to reduce heart rate while formally maintaining or even increasing pumping function.

However, this is not the main effect of the medication. Glycosides cope with this task much better with significantly lower risks to health and life.

Nitroglycerin, in case of heart failure, reduces resistance in the capillary network and pressure in the pulmonary artery, which significantly reduces the risk of an emergency condition, irreversible organic disorders (the so-called cor pulmonale).

For this reason, it is impossible to call the medication useless as part of the treatment of the disease. This is wrong.

But the dosage must be carefully varied and adjusted if necessary. It is impossible to do this on your own. Need help from a cardiologist.

Read more about chronic heart failure here.

Pulmonary edema

In such a case, the medication is also ideal: Nitroglycerin will help reduce pressure in the pulmonary artery, normalize blood flow in the pulmonary circle, which in itself relieves swelling and stagnation.

However, in the case of a long-term emergency condition, things are not so simple. Urgent hospitalization may be required.

Diseases not mentioned above

They were partially touched upon earlier. If you get more specific, the list will look like this.

• Disruption of the gallbladder. Nitroglycerin relaxes the walls of the ducts that remove secretions, expanding them, which leads to rapid removal and relief of stagnation.
• Intestinal problems. Relieves pain and spasm, normalizes the discharge of contents. In some cases, it is much preferable to classical medications like Drotaverine.
• Asthma attacks. Not always and not in all cases. Relieves breathing problems, narrowing of the bronchial lumen, and promotes rapid mucus discharge.
• Pain in the uterine area during spasm is also eliminated through the use of medication. Can be used for dysmenorrhea and painful menstrual cycles. In agreement with the gynecologist.
• Damage to the kidneys, ureters, and other structures of the excretory system. Normalizes the patient's condition, removes discomfort and restores urine output.
• Brain problems. Relieving vasospasm of cerebral structures, which means normalizing cerebral blood flow and eliminating headaches and other neurological manifestations.

It is possible to use Nitroglycerin for tachycardia, but this is not a special indication; it is usually eliminated in parallel, as part of the treatment of the underlying condition, which provokes an increased heart rate.

Interaction with other drugs

Nitroglycerin can be combined with many groups of medications, but you must take it carefully with the following medications :

• When taking drugs from the group of salicylates and nitrates, Nitroglycerin accumulates in the plasma,
• When using drugs from the group of barbiturates and nitrates, increased metabolism of the drug Nitroglycerin occurs,
• Simultaneous use of Nitroglycerin and drugs of the adrenomimetics category, then the effect of adrenomimetics is significantly reduced,
• Nitroglycerin suppresses the properties of the anticoagulant Heparin (with the introduction of Nitroglycerin into the artery),
• The use of antiadrenergic drugs with Nitroglycerin increases the vasodilating (dilates blood vessels) property of the drug,
• The use of antihypertensive medications together with Nitroglycerin increases the hypotensive effect,
• The combined use of tricyclic antidepressants with Nitroglycerin enhances the properties of Nitroglycerin. The same effect occurs from the combined use of the drug with calcium channel antagonists, drugs from the MAO inhibitor group, a group of vasodilators,
• The antianginal effect of Nitroglycerin is enhanced by simultaneous administration of ACE inhibitors, as well as acetylcysteine,
• The vasodilating effect of Nitroglycerin is reduced when used together with: medications of the alpha-adrenergic agonists group, histamines, drugs that stimulate parts of the central nervous system,
• The effect of Nitroglycerin on the vascular system and the heart organ is also reduced with the simultaneous use of drugs that are based on snake venom, as well as bee venom.

Nitroglycerin capsules

Contraindications

There are quite a lot of them, you need to strictly adhere to the list.

• Stably high or critical intracranial pressure. Confirmed by diagnostic methods.
• Glaucoma even during therapy. Because a rapid attack, death of the optic nerve and irreversible changes in vision are likely.
• Cardiac tamponade. Accumulation of fluid or blood in the pericardium (a special sac that encloses a muscle organ). Because the use of Nitroglycerin will inevitably provoke death as a result of cardiac arrest (asystole).
• Intoxication with metal salts and other poisons with the development of pulmonary edema.
• Cardiomyopathy. Thickening of the wall of cardiac structures. Relative contraindication. Depends on the nature of the process and its “neglect”. Read more about the types of cardiomyopathies and treatment methods in this article.
• Pericarditis. Inflammation of the already named bursa.
• A drop in blood pressure to critical levels (below 90-100 per 60, depends on individual characteristics and working blood pressure).
• The same applies to the frequency of contractions of a muscle organ. Severe bradycardia of clearly pathological origin is a contraindication.
• Nitroglycerin intolerance. Allergic reaction. It is relatively rare, but if it develops, the drug is discontinued and not used, replacing it with analogues. Unfortunately, you won't be able to identify the problem without trying. Therefore, they start with the minimum dosage, not counting emergency conditions.
• Polyvalent response to medications. Diagnosed even less frequently. Accompanied by an immune reaction, allergies to a group of drugs.

Attention:
In the main part of the described cases, with low blood pressure, critically low pulse, etc., the use will provoke death.

Therefore, nitrates should not be used without a doctor’s prescription and thorough diagnosis. Especially without knowing your own body and current diseases.

There are also so-called situations when use is acceptable, but not recommended. The standard medical rule applies: Nitroglycerin can be taken if the benefits outweigh the risks.

• Pregnancy.
• Breast-feeding.
• Age 75+.
• Acute disturbance of cerebral blood flow or chronic cerebral ischemia.
• Severe anemia.
• Kidney, liver failure.
• Marked intoxication.

Side effects

Before taking the drug Nitroglycerin, you need to read the instructions and find out its side effects.

Side effects of this medication occur from:

• Heart organ,
• arterial systems,
• Nervous system
• Digestive organs.

Manifestation of side effects from the nervous system:

• Severe and sharp headache,

• 
  The feeling that the skull is bursting from the inside,

• Head spinning
• Weakness throughout the body
• Unsteadiness when moving,
• Visual acuity decreases,
• Glaucoma,
• Irritability,
• Unreasonable changes in mood
• Feelings of anxiety and tension.

From the blood flow system and cardiac organ:

• Flushes of blood in the face
• Symptoms of tachycardia (strong heartbeat),
• A sharp decrease in the hell index,
• Collapse,
• Decreased hemoglobin in the blood,

Side effects from the digestive tract:

• Conditions of heaviness in the stomach,
• Nausea, sometimes severe,
• Vomit,
• Dryness of the oral mucosa,
• Prolonged diarrhea.

Side effects on the skin also appear: cyanosis near the mouth, as well as hyperemia of the skin.

Manifestation of allergies to taking the drug:

• Burning of the skin and mucous membranes,
• Itching on the skin and mucous membranes,
• Dermatitis.

Signs of paradoxical action appear when taking the drug:

• Hypothermia,
• Feeling of heat in the body
• Cardiac ischemia,
• Angina pectoris
• Myocardial infarction with fatal outcome.

Let's summarize

Nitroglycerin can quickly help with heart and some other problems, but is not considered a panacea. Because the effect is partial or absent altogether.

For this reason, and also due to the enormous risks, there is no talk of any unauthorized use. This is extremely dangerous. In all controversial cases, it is recommended to consult a cardiologist.

The only exceptions are emergency situations, when the issue is blunt and life is at stake. Then it makes sense to take a risk and take Nitroglycerin, but you still can’t do without calling an ambulance and transporting to a hospital.