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Right ventricular infarction — ACEM Fellowship MCQ

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HardCardiovascular emergenciesRight ventricular infarctionACEM Fellowship

A 63-year-old has an inferior STEMI with right-ventricular involvement. Blood pressure is 78/52 mmHg, heart rate 54/min, jugular venous pressure is raised and the lungs are clear. Aspirin has been given. What is the best immediate haemodynamic strategy while reperfusion is organised?

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Correct answer: D — Give an isotonic crystalloid bolus with haemodynamic reassessment

The best answer is “Give an isotonic crystalloid bolus with haemodynamic reassessment”. Right-ventricular infarction is preload dependent, so a cautious fluid challenge with frequent assessment may improve output while urgent reperfusion proceeds. Nitrates, diuretics and beta blockade can worsen hypotension or bradycardia in this presentation. Biomarker confirmation must not delay the established STEMI reperfusion pathway.

Reference: National Heart Foundation of Australia: Australian clinical guideline for acute coronary syndromes: https://www.heartfoundation.org.au/for-professionals/acs-guideline