Case 2:

63-year old woman presented with central chest pain of two hours duration. On examination her blood pressure was 90/60 mm Hg, she had a weak pulse, distended neck veins with elevated jugular venous pressure, normal first and second heart sounds and lung fields were clear on auscultation.

Ragavendra R. Baliga, M.D
Assistant Professor
Division of Cardiology
University Of Michigan

 

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Question 8 of 17:

Nitrates should be avoided in this patient.

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Pre-load reducing drugs which are routinely used left ventricular infarction, such as diuretics and nitrates, may reduce cardiac output and produce severe hypotension in right ventricular infarction. One common clinical presentation of right ventricular infarction is the persistent hypotension following administration of sublingual nitroglycerin. The degree of hypotension is usually out of proportion to the electrocardiographic severity of infarction.
 
 
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