Which statement about nitrate use in suspected right ventricular infarction is true?

• A. Nitrates can be given without base hospital contact.
• B. Nitrates should be given even if signs of inadequate tissue perfusion are present.
• C. Nitrates are contraindicated with all PDE-5 inhibitors regardless of timing.
• D. If Right Ventricular Infarction is suspected, base hospital contact is required before nitrate use.

Answer: (D)

In suspected right ventricular infarction, keeping the preload of the heart's right ventricle intact is crucial. The right ventricle depends on venous return to fill and pump effectively. Nitrates cause venodilation, which lowers preload. If the right ventricle is already compromised, reducing preload can drop right‑sided output and blood pressure, worsening perfusion. That’s why management typically involves avoiding nitrates or using them only under careful supervision after confirming the situation and with guidance from experienced clinicians.

Therefore, the true statement is that if a right ventricular infarction is suspected, base hospital contact is required before nitrate use. This ensures you don’t inadvertently reduce preload in a patient who relies on it for maintenance of cardiac output and allows for an appropriate plan (such as fluids to support preload if indicated) based on the clinical picture.

Regarding the other points: giving nitrates without base hospital input is not appropriate in suspected RVI due to the preload dependency and risk of hypotension; giving nitrates when there are signs of inadequate tissue perfusion is unsafe because it can further diminish perfusion; and while there is a dangerous interaction between nitrates and PDE-5 inhibitors, stating it as a blanket, timing‑independent rule is too absolute—timing and context matter, and protocols typically address this interaction with specific guidance.