Right ventricular myocardial infarction and adverse events from nitrates: A narrative review


Myocardial infarction
Right ventricle

How to Cite

Wilkinson-Stokes M. Right ventricular myocardial infarction and adverse events from nitrates: A narrative review. Australasian Journal of Paramedicine [Internet]. 2021Mar.8 [cited 2022Jan.25];18. Available from: https://ajp.paramedics.org/index.php/ajp/article/view/897



There is ubiquitous belief that right ventricular myocardial infarction (RVMI) patients are pre-load dependent, and that administering nitrates to this cohort may cause adverse events – most notably hypotension. This article charts a narrative history of RVMI and nitrates: from the initial recognition of RVMI and early support of the use of nitrates, through the spread of the view against nitrates, and to the recent publication of evidence once again supporting their use.


Four databases were systematically searched (PubMed, Embase, Medline, Web of Science) and results screened by title, then abstract, and finally full text. Results were presented using a chronological narrative structure.


The view against the use of nitrates during RVMI can be traced back to a single 1989 cohort study of 28 patients, then later being adopted by a series of influential secondary evidence papers, and ultimately by international guidelines. In 2016, 2017 and 2019, new cohort studies totalling 1046 patients were presented, all of which concluded that nitrates are safe to administer during RVMI.


This article charts how a single retrospective cohort study with low statistical power came to form the dominant narrative on best practice despite complex and conflicting primary evidence.



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