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RV Infarction — RACP Adult Medicine MCQ

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ModerateCardiologyRV InfarctionRACP Adult Medicine

A 50-year-old man with an acute inferior STEMI develops sudden onset hypotension, raised JVP, and clear lung fields. His ECG shows ST elevation in II, III, aVF and V4R. What is the most appropriate initial management?

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Correct answer: D — IV normal saline bolus

ST elevation in V4R with the clinical triad of hypotension, raised JVP, and clear lungs indicates right ventricular infarction complicating inferior MI. These patients are preload-dependent and require IV fluid resuscitation. Diuretics and vasodilators (including GTN) should be avoided as they worsen hypotension.

Reference: NHF/CSANZ – 2025 – Australian ACS Guideline; eTG – 2025 – Cardiovascular