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

Journal article

Wilkinson-Stokes, Matt. (2021). Right ventricular myocardial infarction and adverse events from nitrates : A narrative review. Australasian Journal of Paramedicine. 18, pp. 1-8. https://doi.org/10.33151/ajp.18.897
AuthorsWilkinson-Stokes, Matt


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.

Keywordsmyocardial infarction; nitroglycerin; right ventricle
JournalAustralasian Journal of Paramedicine
Journal citation18, pp. 1-8
PublisherParamedics Australasia
Digital Object Identifier (DOI)https://doi.org/10.33151/ajp.18.897
Scopus EID2-s2.0-85103260263
Open accessOpen access
Research or scholarlyResearch
Page range1-8
Publisher's version
All rights reserved
File Access Level
Output statusPublished
Publication dates
Online08 Mar 2021
Publication process dates
Deposited22 Nov 2021
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