Nitroglycerin use in STEMI locations
Brenna Heaney1, Kaitlyn Zalar, Marlene Flores
1Brenna Heaney, Kaitlyn Zalar, Marlene Flores, and Sarah Jessee are students at Emory and Henry College in Marion, VA. Elyse Watkins is an associate professor and associate DMSc program director at Northeastern University in Boston, MA. E. Watkins serves as a JAAPA clinical editor. The authors have disclosed no other potential conflicts of interest, financial or otherwise.
Abstract:
Current acute coronary syndrome (ACS) protocols recommend against the administration of nitroglycerin to patients with inferior ST-elevation myocardial infarction (STEMI). Due to nitroglycerin's vasodilatory effects, which decrease preload and cardiac output, protocols warn of a possible critical drop in blood pressure with the drug's use that could be detrimental to patients with inferior STEMI. Research has shown, however, that nitroglycerin-induced hypotension occurs at similar rates in both inferior STEMI and non-inferior STEMI. Rather than the location of the culprit lesion, the development of hypotension depends on individual patient epidemiologic factors. An amendment to current ACS protocols for patients with inferior STEMI is warranted to reflect nitroglycerin's benefits in the preservation of myocardial function. Removing this barrier to the care of inferior STEMI would lead to therapeutic relief and improve patient survival overall.
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