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Angina and CFS/ME: are diuretics and GTN spray counterproductive?

Discussion in 'Autonomic, Cardiovascular, and Respiratory' started by Darach, Dec 31, 2016.

  1. Darach


    After being hospitalised with pneumonia, cardiac arrhythmia and soaring BP and heart rate, I am on Warfarin, beta blocker Bisoprolol and the diuretic Furosemide, with a Glyceryl Trinitrate (GTN) spray for angina episodes.

    (1) While a diuretic was understandable while I had pneumonia, if a problem with CFS is low blood volume wouldn’t a diuretic be counterproductive now, decreasing blood volume further when it is already too low?

    (2) While I suffer from angina, my angiogram was clear. My angina doesn’t seem to be caused by the usual culprit of narrowed blood vessels reducing oxygen supply to cardiac muscles.

    It does fit the CFS explanation of mitochondria in the heart not producing enough ATP fuel, and the heart having to switch to anaerobic respiration, with a resulting build up of lactic acid and muscle pain.

    In normal angina, GTN spray expands the blood vessels allowing more oxygen to the heart - problem solved. But if oxygen supply is ok, for someone with CFS and resulting low blood volume, wouldn’t GTN spray opening up the blood vessels mean the heart has to work even harder pumping blood to the brain?
    Countrygirl likes this.
  2. deleder2k

    deleder2k Senior Member

    Some ME patients say that they feel better after using a spray of GTN. They report that ME symptoms vanish, or are reduced for a few hours or up to a day or two. I am not aware that anyone have experienced getting worse after using GTN. Patients has reported common GTN side effects which include headache and flushing.

    Check this thread out: http://forums.phoenixrising.me/inde...ith-or-without-b-cell-depletion-in-cfs.36592/
    Darach likes this.
  3. MeSci

    MeSci ME/CFS since 1995; activity level 6?

    Cornwall, UK
    I don't know a great deal about this, and don't have very good reasoning power at the moment, but I would query it with the doctors. Furosemide doesn't sound wise. But medics don't know much about M.E./CFS. They should check your blood volume.
    Darach and Countrygirl like this.
  4. kangaSue

    kangaSue Senior Member

    Brisbane, Australia
    In that case, it's more likely to be microvascular ischemia from an altered vasodilation/vasoconstriction response. I've seen it mentioned in a few articles that in those with ME/CFS, there is often a lack of the plaque build-up that usually causes ischemia. A GTN patch or one of the longer lasting nitrates is the usual medication for microvascular ischemia.
    Darach likes this.
  5. ryan31337

    ryan31337 Senior Member

    South East, England
    With onset and symptoms like that + existing CFS diagnosis I would think investigation for POTS would be sensible. Probably didn't occur to your doctors though.

    In the case of a POTS diagnosis a diuretic would usually be bad news.
    Darach likes this.
  6. dangermouse

    dangermouse Senior Member

    I had pneumonia in 2015 and was later admitted to hospital with chest pain. I had lots of tests and an Angiogram which was clear. I was diagnosed with Microvascular Angina. As the usual medicine for Angina lowered my blood pressure too much (with having ME) I was prescribed Ranolazine which helps to manage the Angina pain. I have GTN spray for breakthrough episodes.
    Darach and Countrygirl like this.

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