During an angina episode in a known patient, what should you help them take?

• A. Glyceryl trinitrate spray under the tongue.
• B. Prilocaine with felypressin.
• C. Adrenaline.
• D. Paracetamol.

Answer: (A)

When angina occurs in a known patient, the immediate goal is to relieve the ischemia quickly by opening up the coronary vessels and reducing the heart’s workload. Glyceryl trinitrate given as a sublingual spray acts rapidly because it’s absorbed through the mouth lining and causes quick vasodilation. This lowers preload and afterload and improves blood flow to the heart, often easing or stopping the chest pain within minutes.

So you should help them use a spray under the tongue right away. If the pain persists after about five minutes, give a second spray, and then a third after another five minutes if needed, totaling up to three doses. Keep an eye on their blood pressure and symptoms, and seek emergency help if the pain isn’t relieved after three doses or if they become hypotensive or unstable.

The other options don’t address the acute ischemic issue: a local anesthetic with a vasoconstrictor, adrenaline, or paracetamol won’t rapidly relieve angina and could worsen the situation.