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Right ventricular myocardial infarction — ABEM Board MCQ

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HardCardiovascular emergenciesRight ventricular myocardial infarctionABEM Board

A 58-year-old man is brought to the ED as triage level 1 with crushing chest pressure, diaphoresis, and BP 84/52 mm Hg. ECG shows 2-mm ST elevation in II, III, and aVF with ST elevation in V4R. Lungs are clear and oxygen saturation is 96% on room air. Which of the following is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: B — Activate the catheterization laboratory and give aspirin while avoiding nitrates

Right ventricular STEMI requires immediate reperfusion and antiplatelet therapy; nitrates can precipitate profound hypotension by reducing preload.

Reference: AHA/ACC acute coronary syndrome guidance; ABEM EM Model