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Inferior STEMI with right ventricular infarction — SCE Acute Medicine MCQ

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ModerateAcute Cardiac PresentationsInferior STEMI with right ventricular infarctionSCE Acute Medicine

A 69-year-old woman presents with acute chest symptoms with haemodynamic concern. Relevant history includes cardiovascular risk factors or structural heart disease. On assessment, haemodynamic findings and ECG changes are present. Investigations show inferior ST elevation with V4R elevation, raised JVP and clear lungs. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Give cautious intravenous fluid and arrange immediate primary PCI

The key discriminator is that inferior ST elevation with V4R elevation, raised JVP and clear lungs, which makes Give cautious intravenous fluid and arrange immediate primary PCI the single best answer. Give intravenous fluids with reassessment is less appropriate because it does not address the dominant acute risk in the vignette; Provide supportive care and close monitoring would fit a different presentation or later stage of care. Call critical care for escalation and Optimise chronic medication and discharge are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE NG185; ESC ACS guidance