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Nitroglycerin Latest Medication Shortage
© CBC Fast-acting sprays are particularly difficult to access. Nitroglycerin, which is used to treat heart pain, has been difficult to come by recently, joining a long list of drugs that have faced shortfalls in the last few years.
"It is frustrating because this isn't the only medication that is shorted," said Sheri Koshman, a cardiac pharmacist and professor in the cardiology division at the University of Alberta.
"There's all kinds of medication that is shorted all the time, and it's always this circle that goes round and round and round."
In recent months shortages of painkillers and antibiotics have also been reported.
Nitroglycerin can be used for long-term control and quick relief of heart pain, and it is the latter type where there is a shortage. Nitroglycerin dilates arteries and veins, so someone with blockages in their heart arteries can use it to open them up a little more.
For some people, nitroglycerine is an option they keep on hand but rarely use, and they will probably be OK during this shortage, said Koshman. The drug is safe to use up to a year after its expiry date, she said.
"We're telling people who have chest pain and are having to use their nitroglycerine regularly, and are perhaps running out, that they should probably see their physician to have their chest pain control reassessed," said Koshman.
"People that are needing it, and often, they should probably be reassessed by their health-care provider anyway."
The drug is really a pain treatment, and in that way not critical, she said. The important thing when experiencing heart pain is to sit down and rest. Giving your heart a break will also ease the pain.
If it doesn't go away, said Koshman, then you should seek emergency care. You may be having a heart attack.
What To Know About Artery Spasms
Coronary arteries are blood vessels that wrap around the heart and give blood and oxygen to the entire heart muscle. The walls of arteries have muscles themselves, and a coronary artery spasm is a tightening of those muscles. Depending on how long the spasm lasts, the blood flow to your heart can either be limited or completely blocked.
Usually, a coronary artery spasm will take place in an artery that is not clogged with plaque buildup, but it can also happen with arteries that do have plaque inside them. It also typically only happens in one part of the artery.
These spasms usually happen suddenly and can be brought on by:
Among the strongest triggers of coronary artery spasms are cigarette smoking and stimulants. In particular, cigarette smoking significantly increases your chances of getting arterial spasms and quitting smoking decreases your chances.
But sometimes when a spasm occurs, there is no cause to point to.
Coronary arterial spasms usually have no symptoms unless they're strong enough to cause chest pains. You may feel such pain during physical activities or stress. But it should be noted that only 2% of people who have chest pain are experiencing a coronary artery spasm or variant angina.
Variant Angina. When you have chest pain that is due to not enough blood flow to the heart, you are said to have angina. A coronary artery spasm that involves pain can bring on a rare condition called variant angina. It's also called Prinzmetal's or Prinzmetal angina, or angina inversa.
Variant angina usually happens in younger people who do not have any other type of heart condition, and it can affect them during rest. And because chest pain is usually a sign that you have heart disease, it is important that you seek medical treatment if you think you are experiencing variant or any other type of angina.
Usually, if you feel chest pain from a coronary artery spasm, you will feel it under the sternum (breast bone), on the left. This pain is very intense, and it can feel like your chest is being squeezed. Occasionally, these sensations can spread to other parts of the body like the neck, arm, shoulder, or jaw.
Coronary artery spasms usually happen during sleep at the same time each day. They can last for up to 30 minutes and sometimes result in a loss of consciousness.
After you go to the doctor and describe your symptoms, your doctor will give you some tests.
An electrocardiogram. This tests the electrical signals of your heart. It requires no preparation and does not take very long to conduct. Electrocardiograms can detect abnormal heart patterns both during a spasm and after one.
Echocardiogram. An echocardiogram is essentially an ultrasound for the heart. Your doctor will be able to map out your heartbeat through a sonic test. They will place a wand on the top of your chest that can pick up high-frequency sound waves. These sounds allow them to paint a picture of the different parts of your heart.
Coronary angiography. This may be the best way to detect if you have a coronary artery spasm. This test involves a procedure in which your doctor will inject contrast dye into a blood vessel.
The doctor will then take an X-ray of your heart. The X-ray will show whether you have any blockages.
Ambulatory monitor. You may need to spend 24 hours or more on an ambulatory monitor, a device that records your heart rhythms as you go about your business. The monitor will show your doctor your heart's patterns and possible spasms at all times of the day.
The risks of coronary artery spasms are quite significant. Depending on how bad the blockage is, you are at risk for several different conditions, including cardiac arrest, organ failure, heart failure, or even sudden death. While having spasms is a chronic condition, there are many treatment plans out there that can keep you safe.
You must consult your doctor to find out what would be right for you. Still, some of the most common medications prescribed are:
In addition to medication, you should also make these lifestyle changes (if you haven't already):
What To Know About Spontaneous Coronary Artery Dissection (SCAD)
Spontaneous coronary artery dissection (SCAD) occurs without warning and can lead to serious complications, including death. Symptoms can include chest pain, shoulder pain, shortness of breath, and more.
In the past, people believed SCAD was rare. Research now suggests that the issue may be underreporting, meaning that the true number of cases may be higher than people originally thought.
Those who develop SCAD do not typically have any risk factors for cardiac disease. They are also often younger than 50 years old and female. With treatment, most people can survive SCAD.
This article reviews what SCAD is, its symptoms, risk factors, treatment, and more.
Sex and gender exist on spectrums. This article will use the terms "male," "female," or both to refer to sex assigned at birth. Click here to learn more.
SCAD occurs when the innermost layer of the coronary artery (the artery that supplies blood to the heart) suddenly tears without warning, allowing blood to pass into the inner chamber.
The trapped blood then bulges inward, causing a blockage. It may also extend the tear, which can lead to a heart attack due to loss of blood.
In the past, experts believed that this condition was rare, but newer evidence suggests it may be more common than previously thought. In either case, SCAD can be life threatening and requires immediate medical treatment.
Signs and symptoms of SCAD resemble those that people associate with heart attacks. However, unlike a heart attack, about 80% of people seen who have SCAD are "fairly young, healthy, and active."
Biological females have a higher chance of experiencing SCAD, as about 10–15% of cases occur in males.
SCAD occurs spontaneously and suddenly. Though researchers have not yet defined the exact cause of SCAD, it occurs when a tear appears in the inner layer of the coronary artery.
The tear allows blood to flow into a cavity, which creates an abnormal bulge. The bulge in the artery can block blood flow to the heart. Without treatment, this can lead to a heart attack.
The presentation of SCAD symptoms is similar to those of a heart attack. They can include:
When tested, a person will also likely present with increased levels of cardiac enzymes, which indicate damage to the heart muscle (though these are not specific to SCAD).
As with any type of heart attack, recognizing signs quickly and seeking medical attention helps increase survival. An individual experiencing signs of a SCAD heart attack should seek immediate medical attention or call 911.
Diagnosis presents a challenge to doctors because people often lack common risk factors of cardiac disease. If a doctor suspects a person may have SCAD, they may perform several diagnostic tests to check for the condition.
Testing for SCAD often includes:
There are no other biomarkers in the blood to indicate SCAD, but a person typically has elevated troponin levels.
Some other possible diagnostic tools a doctor may use include:
SCAD resembles a heart attack, but it requires a different treatment plan. Due to limited knowledge about the condition, there is no standard treatment plan for a doctor to follow.
Instead, a doctor will need to assess the location of the tear as well as the person's symptoms.
Doctors often prefer conservative therapies, such as medications, to more invasive methods, such as stent placement. However, they may recommend the following:
People may also require a heart transplantation.
Often, a person will not know they have SCAD until they experience a heart attack. They also may not suspect any issues because people who often develop SCAD do not typically have the risk factors associated with heart disease or heart attack.
According to a 2018 study, risk factors for SCAD may include being biologically female and being pregnant.
Some other risk factors may include:
Without treatment, SCAD can lead to major complications. These can include:
With prompt medical attention, a person will likely survive SCAD. However, they will often need continued monitoring due to the risk of relapse.
About 1–5% of people who develop SCAD will not survive it, with another 14% needing hospitalization to treat the condition.
Females, particularly those who are postpartum, tend to have a worse outlook than others.
SCAD is a spontaneous, sudden break in the inner wall of the coronary artery.
When it occurs, it can cause a person to have a heart attack and can lead to death.
A person who has SCAD does not typically have the warning signs and risk factors associated with heart disease. They also tend to be younger than those who are typically most at risk of a heart attack. Females are more likely to develop SCAD than males.
With treatment, most people recover from SCAD, though they have a higher chance of developing it again than someone who has never had SCAD.
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