skip to main content

Right ventricular myocardial infarction — DipIMC MCQ

Instant feedback + full explanation. One question, done properly.

HardMedical EmergenciesRight ventricular myocardial infarctionDipIMC

A 49-year-old man with crushing chest pain becomes hypotensive after taking his own glyceryl trinitrate. ECG shows inferior STEMI with possible right ventricular involvement. What is the most appropriate immediate action?

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

Reveal the answer and explanation

Correct answer: A — Avoid further nitrates and expedite reperfusion pathway with cautious haemodynamic support

Inferior STEMI with hypotension after nitrates raises concern for right ventricular infarction, where further nitrates may worsen preload-dependent shock. The priority is reperfusion pathway activation, monitoring and cautious support. Diuretics can also worsen preload depletion. The pearl is that response to GTN can reveal haemodynamic vulnerability rather than reassure.

Reference: JRCALC Guidelines 2025; NICE Acute Coronary Syndromes NG185