Dear Paula, here's a few references for you, peruse at your leisure. http://www.bestbets.org/bets/bet.php?id=75 Am also intirgued to hear about a patient with cardiogenic shock, quite happily sitting up in a wheelchair, who'll die with a dose of GTN. You don't reference your claim - would you mind doing so for my education? I'm also concerned that my grandma doesn't have a BP monitor at home, yet has a diagnosis of heart failure and angina, and uses GTN. I am deeply concerned she may self administer GTN without knowing her own blood pressure and die! Although she does have a nice house which i've had my eye on for a while - perhaps I should suggest she has TWO puffs of GTN next time, just to finish her off? (could I have one of those irony tags please tom, just in case paula reports me to the GMC for having a murderous nature). Checking BP all well and good if there's a sphyg handy, otherwise a conscious patient who doesn't look white, and has a decent pulse would be fine for me. :) Jon