Nitroglycerin-induced hypotension occurs at similar rates in inferior and non-inferior STEMI, suggesting protocols restricting its use in inferior STEMI should be amended.
Does nitroglycerin administration improve survival and preserve myocardial function without disproportionate hypotension in patients with inferior STEMI?
The authors argue that current ACS protocols should be amended to allow nitroglycerin use in inferior STEMI, as the risk of hypotension is similar to non-inferior STEMI and depends on individual patient factors.
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.
Heaney et al. (Tue,) conducted a review in inferior ST-elevation myocardial infarction (STEMI). Nitroglycerin was evaluated on hypotension. Nitroglycerin-induced hypotension occurs at similar rates in inferior and non-inferior STEMI, suggesting protocols restricting its use in inferior STEMI should be amended.