Indications for initiating IV nitroglycerin in STEMI include which of the following?

Indications for initiating IV nitroglycerin in STEMI include which of the following?

• A. Recurrent or continuing chest discomfort unresponsive to sublingual nitro
• B. Pulmonary edema complicating STEMI
• C. Hypertension complicating STEMI
• D. All of the above

Answer: (D)

IV nitroglycerin in STEMI is used when you need to reduce the heart’s oxygen demand and improve perfusion by dilating veins (lower preload) and, at higher doses, dilating arteries (lower afterload). Recurrent chest discomfort that persists despite sublingual nitro shows ongoing ischemia that often responds to a continuous IV infusion. In pulmonary edema complicating STEMI, IV nitro lowers LV filling pressures and reduces preload, helping to unload the failing ventricle and improve pulmonary congestion. When hypertension is present with STEMI, IV nitro lowers systemic vascular resistance and afterload, which can improve coronary perfusion and reduce myocardial wall stress. Because of these effects, all these situations are appropriate indications for initiating IV nitroglycerin in STEMI, with careful hemodynamic monitoring to avoid hypotension and other contraindications.

IV nitroglycerin in STEMI is used when you need to reduce the heart’s oxygen demand and improve perfusion by dilating veins (lower preload) and, at higher doses, dilating arteries (lower afterload). Recurrent chest discomfort that persists despite sublingual nitro shows ongoing ischemia that often responds to a continuous IV infusion. In pulmonary edema complicating STEMI, IV nitro lowers LV filling pressures and reduces preload, helping to unload the failing ventricle and improve pulmonary congestion. When hypertension is present with STEMI, IV nitro lowers systemic vascular resistance and afterload, which can improve coronary perfusion and reduce myocardial wall stress. Because of these effects, all these situations are appropriate indications for initiating IV nitroglycerin in STEMI, with careful hemodynamic monitoring to avoid hypotension and other contraindications.