An 58-year-old man with inferior STEMI has ST elevation in lead V4R, jugular venous distension, clear lung fields, and hypotension at 84/56 mmHg. Which drug must be strictly avoided in this patient?
- A Aspirin 300 mg chewed
- B Sublingual nitroglycerin for pain relief ✓
- C Clopidogrel loading dose
- D Morphine for refractory pain
Explanation
ST elevation in V4R indicates right ventricular infarction accompanying the inferior MI. The infarcted right ventricle becomes preload dependent, maintaining output by high filling pressures transmitted through the pulmonary circulation. Nitrates reduce preload, abruptly drop right ventricular filling and can precipitate profound hypotension and cardiovascular collapse. Diuretics carry the same hazard. Management rests on volume expansion to maintain preload, inotropic support if needed, and prompt reperfusion; aspirin, clopidogrel and cautious analgesia remain appropriate.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.