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Inferior myocardial infarction — DIPIMC MCQ

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HardMedical EmergenciesInferior myocardial infarctionDIPIMCDipIMC

A 65-year-old has chest pain, and an ECG shows ST elevation in leads II, III and aVF. His blood pressure is 88/56 mmHg and his lungs are clear. A right-sided lead shows ST elevation in V4R. The crew is about to give sublingual GTN for the pain. What is the most appropriate action?

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Correct answer: E — Withhold GTN, give cautious intravenous fluids, and pre-alert for primary PCI

ST elevation in the inferior leads with V4R changes indicates right ventricular involvement, which is preload-dependent, so nitrates can cause profound hypotension and are withheld, while cautious fluids support the pressure and the patient is pre-alerted for primary PCI. Beta-blockade can worsen hypotension and bradycardia here. Combining a fluid bolus with a vasodilator is contradictory and unsafe. Pearl: hypotension with clear lungs in inferior myocardial infarction should raise suspicion of right ventricular infarction.

Reference: JRCALC Clinical Guidelines