Nitroglycerin use in STEMI locations

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.