Nitroglycerin is considered for chest pain under ICEMA standing orders when the patient’s systolic BP is above what threshold and there is no contraindication?

• A. SBP ≥ 100 mmHg.
• B. SBP ≥ 120 mmHg.
• C. SBP ≥ 90 mmHg.
• D. SBP ≥ 140 mmHg.

Answer: (A)

The central point is that nitroglycerin should only be given for chest pain when the patient is hemodynamically stable, because nitrates lower preload and blood pressure. The threshold used in ICEMA standing orders is a systolic blood pressure of 100 mmHg or higher; below this, giving nitroglycerin risks dangerous hypotension and reduced coronary and organ perfusion. If the patient’s SBP is at or above 100 and there are no contraindications—such as recent use of phosphodiesterase inhibitors, suspected right ventricular infarction, or other conditions where reducing preload could be harmful—nitroglycerin can be considered to help relieve ischemia by dilating veins, reducing preload, decreasing myocardial oxygen demand, and alleviating chest pain.