Case Resolution

The patient is having eight out of 10 chest pain and the ECG suggests an inferior MI with possible right ventricular involvement. You know the latest evidence doesn’t support the contraindication of nitroglycerin administration and that it might ease his pain. At the same time, you know that any patient with an MI might become hypotensive, so before providing the first spray of nitroglycerin you establish an intravenous line.

Thank you to Dr. Rupinder Sahsi who works as an emergency physician in Kitchener-Waterloo, Ontario, Canada and is an assistant medical director for EMS at the Centre for Paramedic Education and Research in Hamilton, Ontario, Canada for his assistance with this critical appraisal.

Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine.

References

1. Neumar RW, Shuster M, Callaway CW, et al. Part 1: Executive summary. Circulation. 2015;132:S315–67.
2. Ferguson JJ, Diver DJ, Boldt M, et al. Significance of nitroglycerin-induced hypotension with inferior wall acute myocardial infarction. Am J Cardiol.1989;64:311–4.
3. Robichaud L, Ross D, Proulx M-H, et al. Prehospital nitroglycerin safety in inferior ST-elevation myocardial infarction. Prehosp Emerg Care. 2016;20:76–81
4. McConnell AH, Davis M, Van Aarsen K, et al. LO33: prehospital adverse events associated with nitroglycerin use in STEMI patients with right ventricle infarction. CJEM. 2017;19:S39.