1
Nitroglycerin Contraindications
Screening before sublingual nitro administration
Severe anemia
Aortic stenosis
Narrow angle glaucoma
Hypertrophic obstructive cardiomyopathy (HOCM)
History of intracranial hemorrhage (brain bleed)
Known allergy to nitroglycerin
Medication Review — taking any of the following?
Long-acting nitrate
Prevent chest pain — ISMO® · Monoket® · Isordil® · Dilatrate-SR®
Phosphodiesterase inhibitor
e.g. Sildenafil (Viagra®), Tadalafil (Cialis®), Vardenafil
Soluble guanylate cyclase stimulator
e.g. Riociguat (Adempas®)
Alpha-adrenergic agonist
Midodrine · ProAmatine®
2
Iodinated Contrast Contraindications
Screening before IV contrast administration
Pregnancy
Previous anaphylaxis to iodinated contrast
Severe allergic reaction requiring epinephrine or hospitalization
3
Beta-Blocker Contraindications
If heart rate ≥65 bpm and beta-blocker is needed
Second or third-degree AV block
Without a permanent pacemaker in situ
Systolic blood pressure ≤ 90 mmHg
Hemodynamic instability or cardiogenic shock
Active bronchoconstriction, asthma, or bronchospastic disease with regular inhaler use
4
Elevated Troponin
Acute coronary syndrome exclusion
Elevated troponin > 50 ng/L (or institutional threshold)
Positive troponin suggests ACS — CTA may not be appropriate in the acute setting
Decision Support
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⚕ Clinical decision support tool only. Final decisions rest with the ordering physician and radiologist. Verify against current institutional protocols and patient clinical context.