Which of the following is a typical in-flight contraindication to nitroglycerin administration?

• A. Hypotension
• B. Normal blood pressure with tachycardia
• C. Chronic stable angina
• D. Recent use of aspirin

Answer: (A)

Low blood pressure is the main reason nitroglycerin would be avoided in flight. Nitroglycerin dilates veins and lowers preload, which can drop blood pressure further. In a flight situation with limited monitoring and potential dehydration, a already-low BP can lead to dizziness, syncope, or worse, because the cabin environment and reduced oxygen can make rebounds harder. So a low systolic BP is a clear contraindication to giving nitroglycerin mid-flight.

The other situations don’t by themselves prevent nitroglycerin use: normal blood pressure with tachycardia isn’t a contraindication if perfusion remains adequate; nitroglycerin is commonly used for chest pain from chronic stable angina; and aspirin use does not negate nitroglycerin therapy.