Why is it that some doctors just give a patient a prescription for nitroglycerin when then come in for the first time complaining of chest pain? No work up done! No stress test. No nuclear scan. No cath. No squat! If you ask me it is serious idiocy or laziness on the part of the MD. You should not take NTG unless you are proven to have stable angina (with documented or very highly suspected stable coronary artery disease not amenable to surgery or stenting that causes the pain). The other day I had a 60 year old lady who was popping NTG left and right for weeks when she would have either nausea, chest pain, abdominal cramps or “just didn’t feel well”. She came in because she was found passed out in the bathroom. The NTG drops your blood pressure and can cause passing out very easily if overtaken or if your pressure was already low. Her family stated they had seen a doc for the first time about 6 months ago as a walk in and he just gave her the nitro and sent her on her way with no workup. No wonder she passed out. When is asked about her chest pain – it was very vague and could easily have been something besides angina causing it. She got admitted for a proper work up.
Some docs are idiots.
Certainly some (probably many) docs are idiot BUT…I can’t even count how many times a patient, or their relatives, come to me pretending that no one has explained to them how, when and why a drug has to be taken…and it turns out that you, or someone else you can trust, has already told them almost a hundred times. That is just because they are ashamed of saying they didn’t understand…or simply they didn’t listen to you at all.
I am not saying this is your case, but I wanted to share this common experience with you…it becomes a little frustrating when you spent energy and time in explanations.
Dang, we must work in the same city. See this all the time. Pts given SL NTG for atypical CP that has not been evaluated and they take it for every little twinge they may feel. Had one guy who had PAF which had not been diagnosed by his PCP – but he was given SL NTG for vague cardiac sx. He’d take the SL NTG each time he had sx (which correlated with his PAF) and just about had syncope each time.
OTOH, the patients with real CAD and minimal revasc options tend NOT to use their NTG when they have angina.
Is there any difference between PCPs who give SL nitro to anyone and the ER docs who slap on nitro paste (or even worse, start a nitroglycerine drip) to anyone who says they have chest pain?
3 days of chest pain, CPK of 60, troponin zero, normal EKG, pt eating a bag of potato chips but he’s on a nitro drip so he has to go to CCU.
It’s not just family medicine docs who are idiots.
Story on TV yesterday about a woman who had gotten her husband’s nitro paste and hemorrhoid cream mixed up and was slathering nitro on his nether region everytime he used the bathroom. I’m sure you know the result of that.
You are right Erik – any doc who just randomly throws NTG on is not thinking. However, if done in the ER where the patient can be watched and have the BP checked is much safer. I would NEVER discharge someone with NTG pill, paste or patches without a confirmed diagnosis. This guy (a local doc in the box who has no residency training (just an internship and passed step 3 of the boards) just gave her the Rx and told her to take it when she had chest pain. I asked the patient and family what tests or work up he did and they said an EKG and nothing else. Just sent on her way.
One pharmacy where I did relief work had a customer who came in with a fistful of prescriptions from a cardiologist in another town. The usual pharmacist said that she was constantly refilling her husband’s Nitrostat and when he questioned her about it, she said she was using them for her hiatal hernia.
Um, lady, we cannot diagnose but if you have a hiatal hernia, that’s not what’s causing your problem.
Can you do anything about this doctor through the state medical board? Or is that just a huge headache and not worth the effort?