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Inferior STEMI with right ventricular infarction — RCPSC EM MCQ

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ModerateCardiovascular emergenciesInferior STEMI with right ventricular infarctionRCPSC EM

CTAS 2: A 62-year-old has crushing chest pain and diaphoresis 45 minutes after snow shovelling. Vitals are BP 84/52, HR 48, SpO2 95% on room air. ECG shows ST elevation in II, III and aVF with ST elevation in V4R. Chest is clear and JVP is elevated. What is the most appropriate initial management?

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

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Correct answer: C — A cautious crystalloid bolus with urgent reperfusion activation

Inferior STEMI with right ventricular involvement is preload dependent. Avoid nitrates and diuretics; give cautious fluid while activating PCI or thrombolysis according to local access.

Reference: CCS acute coronary syndrome guidance; ACLS; Royal College EM Objectives