It is a self-empowering act. Many years of experience in cardiology persuades me that patients with angina who use nitroglycerin properly feel more in control and, consequently, have a better prognosis. A common practice is to hand the patient a prescription, with the sole instruction to put the pill under the tongue during chest discomfort. The doctor often alerts the patient that the use of TNG may be associated with lightheadedness or a throbbing headache. They generally reserve it for a more severe episode of angina that does not immediately abate when they stop whatever they are doing.
Many factors account for the reticence in using nitroglycerin.
In the first place, patients commonly harbor the superstitious notion that the less they resort to TNG, the less serious their affliction. Some fear addiction, habituation or loss of nitrate efficacy when they might really need it. Some are impeded because of wariness to expose their condition when others are present for fear of losing a job or arousing undue anxiety in a spouse. A common rationalization is that since the discomfort is transient, far preferable to taking a pill is to stop the exertion that provoked the angina in the first place. Disquiet of experiencing severe headache, as warned by their doctor, or having other adverse symptoms are additional reasons for avoiding the free use of this remarkable medication.