Answer: There was a previous Ask MAC (Nov 22, 2012) that responded to a similar question regarding treating “suspected ischemic chest pain” with nitroglycerin. Due to the risk (hypotension) and limited benefit (symptom improvement, mortality neutral) the SWORBHP Medical Directors agreed that, “in order to meet the indications for NTG administration “suspected cardiac ischemia” should encompass some form of discomfort which is consistent with cardiac etiology which in turn would allow a paramedic to gauge the response and indicate the need for further NTG administration.” If your patient’s atypical symptoms consisted of discomfort that you could gauge, then yes, it could be given. However, if her atypical symptoms were nausea only, then nitroglycerin should not be administered.