Advanced Cardiovascular Life Support (ACLS) Practice Exam

Which of the following is a contraindication to nitroglycerin administration in acute coronary syndromes?

1. Left ventricular infarction

2. Right ventricular infarction and dysfunction

3. Stable angina

4. Aortic stenosis

The correct answer is: Right ventricular infarction and dysfunction

Nitroglycerin is a potent vasodilator that is commonly used in the management of acute coronary syndromes to relieve chest pain and improve coronary blood flow. However, there are specific clinical situations where its use may not be appropriate due to the risks associated with further decreasing preload or blood pressure. In the case of right ventricular infarction and dysfunction, administering nitroglycerin can significantly reduce venous return to the heart. This is particularly concerning because the right ventricle is already compromised due to the infarction, leading to decreased cardiac output and potential for systemic hypotension. Patients with right ventricular infarction often rely on adequate venous return to maintain their cardiac function; hence, the use of nitroglycerin could exacerbate their condition and lead to serious complications such as cardiogenic shock. In contrast, left ventricular infarction and conditions such as stable angina or aortic stenosis have different implications for nitroglycerin use. For example, patients with left ventricular infarction may still be able to tolerate nitroglycerin, and while aortic stenosis does require caution, it does not present the same immediate risk of deteriorating cardiac function as right ventricular dysfunction. Thus, recognizing right ventricular infarction as a contraindication is critical