A 68-year-old man presents with acute inferior STEMI. He is hypotensive (BP 84/52 mmHg) with distended neck veins and clear lung fields. ECG shows ST elevation in II, III, aVF, and V4R. Which is the most appropriate immediate management?

• A Intravenous furosemide 40 mg
• B Sublingual nitroglycerin
• C Intravenous dobutamine infusion
• D Intravenous normal saline bolus ✓

Explanation

Right ventricular infarction complicates inferior STEMI in up to 50% of cases. It presents with hypotension, elevated jugular venous pressure, and clear lungs because the failing RV reduces LV preload. Treatment is aggressive IV fluid resuscitation to maintain RV preload. Nitrates and diuretics are contraindicated as they reduce preload and worsen hypotension. Dobutamine is reserved if fluids fail.

Reference: Braunwald's Heart Disease, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.