A 64-year-old with an inferior STEMI becomes more hypotensive after sublingual glyceryl trinitrate. Blood pressure is 78/50 mmHg, the jugular venous p...

Question

A 64-year-old with an inferior STEMI becomes more hypotensive after sublingual glyceryl trinitrate. Blood pressure is 78/50 mmHg, the jugular venous pressure is raised and the lungs remain clear. Right-sided lead V4R shows ST elevation, and echocardiography shows right-ventricular dilatation with preserved left-ventricular systolic function. Primary PCI is being arranged. Which immediate haemodynamic measure is most appropriate?

Accepted Answer

Give a cautious intravenous crystalloid bolus with repeated clinical reassessment

Answer

Start an intravenous nitrate infusion while maintaining systolic pressure above 80 mmHg

Answer

Start dobutamine before assessing whether right-ventricular preload is inadequate

Answer

Give intravenous furosemide because the raised jugular venous pressure indicates congestion

Answer

Insert an intra-aortic balloon pump before giving any preload-directed treatment

Perioperative Risk Assessment — MRCP Part 1 MCQ