I'd like to get a bit more understanding about right side MI's. I was working with two medics last night (I'm a basic) and they know I like to ask questions and they are great at trying to make me understand... but there's a part of this I'm not getting. He asked me "what cardiac patients do we NOT give Nitro to?" (later he explained that you can, CAREFULLY and he was trying to give an example where you don't just say if-chest-pain-then-nitro). So we had quite a bit of discussion about this. I certainly "get" the idea of an inferior MI, and apparently something like 40% or more have right side involvement. I get the concept of cardiac preload, I suppose and I get that the RV is physiologically a lot different than the LV. Of course I learned well that nitro is a dialator and can cause a significant/severe drop in BP. And obviously I get that there is a risk of a RVMI patient with a bp of 150+/90 crashing to 60 over nothing because I've now heard several first and second hand stories about it happening. But honestly what I don't really get is what is going on here physiologically? To me, dialation is the container, the vasculature, getting bigger. Why is the EF plummeting? Presumably the RV was already injured in this case and was pumping what it could and was able to maintain a BP (150/90 for example). Does the RV itself also dialate from the nitro? There's something I'm not getting.