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Inferior STEMI with right ventricular infarction — DIPIMC MCQ

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HardMedical EmergenciesInferior STEMI with right ventricular infarctionDIPIMCDipIMC

A man has central chest pain. His ECG shows ST elevation in leads II, III and aVF. His blood pressure is 90/55 and his chest is clear. After a dose of GTN his blood pressure falls further.

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

Reveal the answer and explanation

Correct answer: A — Withhold nitrates, give a cautious intravenous fluid challenge and arrange primary PCI

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as E

Inferior ST elevation with hypotension that worsens after GTN suggests right ventricular involvement, which is preload-dependent, so nitrates should be withheld, a cautious fluid challenge given, and primary PCI arranged. Further GTN (A) or high-dose nitrates (D) will deepen the hypotension. Recognising RV infarction changes the haemodynamic strategy: fluids, not nitrates.

Reference: ESC/NICE acute coronary syndrome; JRCALC