A 72-year-old man is diagnosed with an inferior STEMI. Right-sided ECG confirms ST elevation in V4R, indicating right ventricular involvement. His blood pressure is 95/65 mmHg with jugular venous distension but clear lung fields. Which of the following medications should be AVOIDED in this patient?
- A Normal saline intravenous bolus
- B Morphine sulfate
- C Sublingual nitroglycerin ✓
- D Dopamine infusion
Correct answer: C. Sublingual nitroglycerin
Explanation
Right ventricular infarction requires maintenance of preload. Nitrates and diuretics reduce preload and can worsen hypotension, so they are contraindicated. Volume loading with normal saline is the initial treatment. Inotropes like dopamine are used if hypotension persists despite fluids. Morphine should also be used cautiously.
Reference: Braunwald's Heart Disease, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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