Wondering what your thoughts are in regards to administering nitro to a patient with atypical angina symptoms and no presentation of chest pain. For example, is it ok for us to administer nitroglycerin if a medic is presented with a female patient who states she becomes nauseated from angina and explains she is prescribed nitro for the symptom? I discussed this question with my colleagues and I have found there is a 50/50 split in regards to those of us who would use nitro or not. I think it is a good question to ask given the differencing of opinion in the field.
There was a previous Ask MAC (Nov 22, 2012) that responded to a similar question regarding treating suspected ischemic chest pain with nitroglycerin. Due to the risk (hypotension) and limited benefit (symptom improvement, mortality neutral) the SWORBHP Medical Directors agreed that, in order to meet the indications for NTG administration suspected cardiac ischemia should encompass some form of discomfort which is consistent with cardiac etiology which in turn would allow a paramedic to gauge the response and indicate the need for further NTG administration. If your patients atypical symptoms consisted of discomfort that you could gauge, then yes, it could be given. However, if her atypical symptoms were nausea only, then nitroglycerin should not be administered.