In prehospital chest pain management, under what condition would you consider administering nitroglycerin?

• A. If systolic BP is below 100
• B. If the patient has no chest pain
• C. If systolic BP is adequate
• D. If the patient has sildenafil in the last 24 hours

Answer: (C)

Nitroglycerin is used to relieve chest pain by reducing the heart’s workload and improving blood flow to the heart, but it can lower blood pressure. Because of that risk, you only give it when the patient’s systolic blood pressure is adequate enough to tolerate a potential drop. If the BP is low (below the safe threshold), nitro could cause dangerous hypotension and worsen perfusion. Also, nitrates are not given if the patient has recently taken sildenafil or similar PDE-5 inhibitors, since that combination can produce a dangerous drop in blood pressure. If there’s no chest pain, there’s no indication for nitro. So the condition for administering nitroglycerin in prehospital chest pain is having an adequate systolic blood pressure.