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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

A 64-year-old man presents to a Toronto ED with 40 minutes of crushing chest pain, diaphoresis and nausea. Blood pressure is 84/58 mmHg, heart rate 48/min and oxygen saturation 96% on room air. ECG shows ST elevation in II, III and aVF with ST elevation in V4R. Lungs are clear and JVP is elevated. What is the most appropriate next step?

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Correct answer: E — Activate primary PCI and give cautious IV crystalloid while avoiding nitrates

Right ventricular infarction with hypotension is preload dependent. The priority is reperfusion with primary PCI, antiplatelet and anticoagulant therapy as locally indicated, and cautious fluid resuscitation; nitrates and aggressive diuresis can precipitate collapse.

Reference: Canadian Cardiovascular Society acute coronary syndrome guidance; ACLS; Royal College Emergency Medicine Objectives