This OP relates to my grandmother, who is currently in the hospital under the care of a physician (probably several). I am asking it so I can sort out conflicting and/or possibly erroneous reports I am getting from family members about her care, because I am 1300 miles away and unable to sort anything out directly with the people providing the care (or with my grandmother, whose cognitive abilities at 93 are…not what they once were).
Apparently in the hospital she was given nitroglycerin, upon which her (formerly high) blood pressure dropped almost immediately. Is this necessarily indicative of angina, or would the same thing happen to anyone who had sublingual nitroglycerin administered? I’m guessing the latter, based purely on the Wikipedia description of how it works.
As far as I know, my grandmother has no history of angina, so if the latter is true, maybe I can get my mom to chill the hell out.
Yes, Nitroglycerin is a vasodilator, and will cause blood pressure to drop as all the pipes in your body suddenly get larger. I’m not a doctor, but I don’t see any reason why this would need to be linked to angina.
Nitroglycerin works by being a source of Nitrous Oxide (NO) which is a natural substance the body uses to cause vasodilation, e.g. relaxation of the blood vessels. It is used in hospitals as a emergency vasodilator when a patient is experiencing a Hypertensive Emergency (BP > 180mmHg).
Also, are you sure she actually got Nitroglycerin? There are many other Nitro drugs used in hospitals for hypertensive emergencies, including Sodium nitroprusside.
So, if she doesn’t have a history of Angina Pectoris, then I really doubt she just spontaneously developed it in the hospital.
I have no bloody idea at the moment; all the info I have is at least thirdhand from my mom, who tends to go into hysterics at the least provocation, especially when it involves her mom. Mom also tends to think she knows more than all the doctors. She doesn’t.
True, but it’s possible that she has a history that I just don’t know about. For example, when my (now late) grandfather had cancer, my grandparents decided not to tell the rest of the family until after he was in remission, so that we wouldn’t worry about him.
Really, I’m just trying to get at the actual facts here. It’s not easy, especially thirdhand from 1300 miles away.
A drop in BP upon administration of nitroglycerine is not indicative, by itself, of any pathologic condition. It’s relatively common and we see it in the Emergency Department all the time. It can happen regardless of the route of administration. The usual explanation is a drop in preload (blood coming back into the heart) because of vasodilation. A drop in blood pressure will usually reverse with discontinuation of the medicine, repositioning the patient or a fluid bolus. Intravenous administration of NTG is easily titrated, so that route is commonly used in a hospital setting instead of a sublingual or percutaneous route.
We use nitroglycerine for a variety of things, including angina and congestive heart failure.
Nitroprusside would be a relatively uncommon drug to give a 93 year old patient.
Just to add to what Chief Pedant said, I’ll point out that not only is nitroglycerin used for the treatment of angina and congestive heart failure, but it can also be used as a blood pressure lowering agent (in acute, emergency conditions). In fact, because it works so quickly to lower the blood pressure, nitroglycerin is often used by the residents (postgrad medical trainees) precisely for that effect - to lower BP in situations where it is dangerously high and must be brought down forthwith. On the other hand, not only does its effect on BP wear off quickly, it is also fairly unpredictable in that regard, i.e. it’s effect to lower BP is erratic, with it sometimes having a very pronounced effect, and at other times only a modest, subtle effect. And, it’s for those very reasons that we don’t use it more often to treat high blood pressure.
By the way, and this is especially possible in a 93-year-old, nitroglycerin tends to have an exaggerated effect to drop the blood pressure in people with aortic stenosis (a stuck or narrowed heart valve). Note that the prevalence of aortic stenosis in nonagenarians is around five percent.
It’s not uncommon to use sublingual Nitro in the ER as a diagnostic tool for people without a prior history of angina who might be presenting with their first indication of a cardiac event. As noted, it’s short acting by that route, and if a patients chest pain/‘indigestion’/Lt shoulder pain, etc, get better afterward it’s a strong indication of angina. We also give a GI cocktail (lidocaine, donnatol, Maalox) to some people for the same reason, if their indigestion gets better, it’s probably not their heart.