In which scenario is nitroglycerin indicated?

• A. Pulmonary edema without chest pain
• B. Suspected ischemic chest pain and acute coronary syndrome
• C. Intravenous antibiotics
• D. Severe hyponatremia

Answer: (B)

Nitroglycerin works as a vasodilator that mainly lowers the heart’s oxygen demand by reducing preload (venodilation) and, at higher doses, afterload. This makes it particularly helpful when chest pain is due to myocardial ischemia, because diminishing the heart’s workload can relieve ischemia and relieve anginal symptoms. In the scenario described—suspected ischemic chest pain and acute coronary syndrome—the drug is indicated as part of the immediate management to halt or lessen ischemia.

The other options don’t fit as indications for nitroglycerin. Intravenous antibiotics address infection, not ischemia. Severe hyponatremia requires electrolyte correction, not vasodilator therapy. Pulmonary edema without chest pain isn’t a primary indication for nitrates, though they can be used in certain situations to reduce preload if ischemia is present or pressure overload is contributing, but the clear, standard indication is ischemic chest pain/ACS.