In the management of angina, which action is recommended first?

• A. Give oxygen
• B. Keep casualty sitting upright to assist breathing and maintain airway
• C. Administer GTN spray
• D. Call 999 if no recovery

Answer: (C)

In suspected angina, the quickest way to relieve the pain is to use a fast-acting nitrate. Glyceryl trinitrate spray works fast by dilating blood vessels, which reduces the heart’s workload and improves blood flow to the heart muscle. Giving the GTN spray as soon as chest pain starts addresses the root problem directly and can stop the episode within minutes, provided there are no contraindications. Oxygen is not routinely given unless the person is actually hypoxic, and simply keeping them upright is helpful for comfort but does not treat the ischemia as effectively as the nitrate. If pain continues after a short interval, seek emergency help and consider a second dose if advised.