Management of an acute angina attack

In an acute attack of angina, any precipitating factor - exercise in exertional angina, or lying down in decubitus angina should be stopped, and a fresh glyceryl trinitrate tablet (0.5 mg) should be placed under the tongue. Pain usually recedes within 3 minutes.

When the pain is relieved the trinitrate tablet is spat out or swallowed, in order to minimise the risk of developing side effects, in particular a severe pounding headache.

Frequent or prolonged angina attacks need urgent review and consideration for urgent hospital admission because of possible unstable angina or myocardial infarction.

NICE state with respect to using short-acting nitrate in angina

• offer a short-acting nitrate for preventing and treating episodes of angina.
  • advise people with stable angina:
    • how to administer the short-acting nitrate
    • to use it immediately before any planned exercise or exertion
    • that side effects such as flushing, headache and light-headedness may occur
    • to sit down or find something to hold on to if feeling light-headed
  • when a short-acting nitrate is being used to treat episodes of angina, advise people:
    • to repeat the dose after 5 minutes if the pain has not gone
    • to call an emergency ambulance if the pain has not gone 5 minutes after taking a second dose (1)

Reference:

• 1) NICE (July 2011). Stable angina.