Nitroglycerine relieves angina in part by vasodilating veins. What is the ultimate effect for a client who is prescribed nitroglycerin?
1. Increasing cardiac output
2. Increasing coronary artery perfusion
3. Increasing the heart rate
4. Decreasing contractility
Correct Answer: 4
Rationale 1: Dilation of veins reduces the amount of blood returning to the heart (preload). Decreased preload also causes a decrease in myocardial contractility. Both of these effects will lower cardiac output.
Rationale 2: Nitroglycerine can dilate large arteries but not arterioles, so it cannot increase coronary perfusion to the heart.
Rationale 3: Dilation of veins reduces the amount of blood returning to the heart (preload). This will have no direct effect on heart rate.
Rationale 4: Dilation of veins reduces the amount of blood returning to the heart (preload). Decreased preload causes a decrease in myocardial contractility due to Starling's law of the heart, reducing myocardial oxygen demand.
Global Rationale: Dilation of veins reduces the amount of blood returning to the heart (preload). Decreased preload causes a decrease in myocardial contractility due to Starling's law of the heart, reducing myocardial oxygen demand. Nitroglycerine can dilate large arteries but not arterioles, so it cannot increase coronary perfusion to the heart. Dilation of veins reduces the amount of blood returning to the heart (preload). This will have no direct effect on heart rate.
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