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Family Physician
Family Physician, Doctor
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Experience:  Emergency Medicine and Family Practice for over 26 years
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Hi again. They tried my husband with the patch and the spray.

Resolved Question:

Hi again. They tried my husband with the patch and the spray. However, whenever he used the patch, his symptoms seem to get much worse. What I mean is that he is awesome all day, while on the nitro patch, but as soon as that patch.comes off for the night, everything gets worse. He ends up using the nitro spray sometimes every half hour and he cannot lie down to sleep at all. It is driving him crazy literally. He has to sleep sitting up and it is just not comfortable. When he lies down, his heart pumps so hard, it feels like it is popping out of his chest. Also, if he goes to the restroom, he always has to use the nitro spray upon returning. Is this all normal? Also, he states that he wishes he could just use the patch round the clock, as it feels best when the patch is on, because he says it is almost like crashing when he takes it off. Please help me. They said a year 6 months ago and now they have just left him to die. I don't want to lose him. My children cried the whole Christmas. I just need to know if there is anything I can or should be doing.
Submitted: 1 year ago.
Category: Medical
Expert:  Family Physician replied 1 year ago.
Thank you for your question:

I'm sorry to hear that your husband has been having these ongoing problems. I'm sure you understand that it is both impossible and unethical for a physician to give specific medical treatment advice over the internet. I can however give you some information and suggested topics to discuss with his physicians. You should NEVER change medications without first discussing this with his personal physician.

While there are theoretical advantages to the intermittent (off at night) dosing for the nitro patches, there is some evidence that this may not be necessary in all cases. Here is on study that suggest the anti-ischemic effect with the various dosing patterns.
http://www.ncbi.nlm.nih.gov/pubmed/12766388

I don't know if your husband is a candidate (or has been evaluated for) cardiac transplant.
Customer: replied 1 year ago.

I want to thank you for your response. My husband has a healthy heart but he has artery disease. He had a quadruple bypass 4 years ago but the doctors are saying that with the way it was done, it is impossible to go in and fix it again. I know you cannot ethically give advice persay, butplease understand that we lost our little boy to a drunk driver, and I am not about to sit around and just accept this diagnosis and lose my husband too. They just told us to get our affairs in order, prepare our chilsren and then left him. I just feel that they should monitor him or try and help him. He is 43 years old. This does not seem right. In an era where they can medically do so much, they cannot fix this? It does help his symptoms to wear the patch, but it has to be round the clock or he crashes. Thank you again for your help and input. please accept my apology for any harshness. I mean no disrespect. I just am not ready to accept this.

Expert:  Family Physician replied 1 year ago.
There are a number of options for treatment of advanced coronary artery disease including bypass surgery, angioplasty/stents, atherectomy, and transmyocardial laser revascularization

I agree at age 43, it is difficult to accept the "There is nothing we can do" approach. For this reason, I do believe an evaluation at another center of excellence such at Cleveland Clinic, Mayo Clinic, Johns Hopkins, Texas Heart Institute or Massachusetts General would be very reasonable.
Family Physician, Doctor
Category: Medical
Satisfied Customers: 12654
Experience: Emergency Medicine and Family Practice for over 26 years
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