A 58-year-old man with inferior STEMI develops hypotension (BP 82/50 mmHg). JVP is elevated. Lung fields are clear. ECG shows ST elevation in II, III, aVF, and V4R. Which is the most appropriate initial management?
- A Intravenous furosemide 40 mg
- B Intravenous nitroglycerin infusion
- C Intravenous normal saline 500 mL bolus ✓
- D Intravenous dobutamine infusion
Correct answer: C. Intravenous normal saline 500 mL bolus
Explanation
RV infarction causes RV systolic dysfunction and decreased LV preload, producing hypotension with elevated JVP and clear lungs. These patients are preload-dependent and require volume resuscitation. Diuretics and nitrates reduce preload and worsen hypotension. Inotropes are reserved for fluid-refractory cases.
Reference: Braunwald's Heart Disease, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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