Nitroglycerin IV infusion is titrated to achieve which objective?

• A. Blood pressure of exactly 120/80
• B. Absence of headaches
• C. Ongoing chest pain or ischemia
• D. Normal heart rate

Answer: (C)

The main idea is to use IV nitroglycerin to relieve ongoing chest pain and ischemia. Nitroglycerin dilates veins more than arteries, which lowers preload and reduces wall tension on the heart. This decreases myocardial oxygen demand and can rapidly improve both pain and signs of ischemia on the ECG. Because the goal is to relieve ischemia, there isn’t a fixed blood pressure target to hit; you titrate to the patient’s symptoms and ECG response while keeping blood pressure within safe limits. Absent headaches or a normal heart rate aren’t goals—headache is a common side effect, and reflex tachycardia can occur as a response to vasodilation. So, the objective is relief of ongoing chest pain and ischemia, not achieving a specific blood pressure, preventing headaches, or normalizing heart rate.