EP62: The Spray Under The Tongue

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction: Dr. Warrick Bishop is a practicing cardiologist and author dedicated to educating patients about heart health. In this episode, he discusses an important misconception about sublingual glycerol trinitrate (GTN) spray—the medication sprayed under the tongue for angina chest pain—and explains how its appropriate use differs significantly between stable and unstable angina situations. Key Takeaways: GTN spray is a vasodilator that works by dilating blood vessels to increase blood flow to the heart and reduce anginal pain, though it can cause headaches as a side effect. Stable angina is predictable chest pain that occurs with consistent triggers (like walking a certain distance), whereas unstable angina comes on unexpectedly with minimal exertion or at rest. In stable angina, relying on GTN spray suggests the patient is undertreated with their regular anti-anginal medications and should see a cardiologist to adjust their treatment plan rather than use the spray as a management solution. In unstable angina, GTN spray may temporarily relieve pain but does not address the underlying problem—likely a ruptured plaque with clot formation that could lead to a heart attack. Pain relief from GTN spray in unstable angina should be viewed as a warning sign, not reassurance; it indicates the need for immediate hospital evaluation, not comfort at home. Patients should never assume that GTN spray resolving chest pain means the danger has passed; this false sense of security can delay critical emergency care. Unstable angina represents a serious, high-risk condition that requires urgent hospitalization and proper investigation rather than self-treatment with sublingual medication.