A 60-year-old man is diagnosed with an inferior STEMI. Physical examination reveals jugular venous distension, clear lung fields, and hypotension. ECG shows ST elevation in leads II, III, aVF, and V4R. Which medication should be strictly avoided in this patient?
- A Aspirin
- B Nitroglycerin ✓
- C Morphine
- D Normal saline bolus
Correct answer: B. Nitroglycerin
Explanation
Inferior STEMI with V4R involvement indicates right ventricular infarction. These patients are preload dependent and rely on adequate venous return. Nitroglycerin, a venodilator, reduces preload and can cause severe, refractory hypotension. Initial management requires IV fluids to maintain preload.
Reference: Braunwald's Heart Disease, 12th ed.
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