Which condition warrants caution when using nicotine replacement therapy due to cardiovascular disease?

• A. Serious ventricular arrhythmia
• B. Acute coronary syndrome
• C. Refractory angina
• D. All of the above

Answer: (D)

Nicotine replacement therapy introduces nicotine that stimulates the sympathetic system, raising heart rate and blood pressure and increasing myocardial oxygen demand. In people with cardiovascular disease, this can worsen unstable heart conditions. Serious ventricular arrhythmia is a direct risk because the extra sympathetic stimulation can trigger dangerous rhythms. Acute coronary syndrome means the heart already isn’t getting enough blood, so any additional workload or vasoconstriction from nicotine can worsen ischemia. Refractory angina is chest pain despite therapy; adding nicotine can heighten myocardial oxygen demand and trigger more symptoms. Because all of these scenarios present safety concerns with nicotine exposure, they collectively justify caution, making all of the above the best choice. If clinicians assess such patients, they may opt for alternative quitting strategies or close monitoring rather than routine NRT.