What is the recommended action if a patient with known coronary artery disease has chest pain but has nitrates prescribed?

• A. Wait 20 minutes and monitor
• B. Administer sublingual nitroglycerin as directed; if pain persists after 5-10 minutes, call emergency services; monitor and provide oxygen
• C. Administer aspirin only
• D. Call EMS but withhold nitrates due to risk

Answer: (B)

Chest pain in someone with known coronary artery disease is managed by providing rapid relief with nitrates that are already prescribed for them. Sublingual nitroglycerin acts quickly to dilate veins, lower the heart’s oxygen demand, and improve blood flow to the heart, often easing angina within minutes. Give the prescribed sublingual nitroglycerin now and reassess after about 5–10 minutes. If the pain persists, call emergency services and keep monitoring the patient while providing oxygen as needed. This approach addresses potential ongoing ischemia and ensures urgent care is obtained if a heart attack is developing. Do not delay treatment or withhold nitrates when there are no contraindications, and keep the patient in a comfortable position with ongoing vitals monitoring.