A patient develops right ventricular infarction complicating inferior STEMI. She is hypotensive and bradycardic. Which treatment is CONTRAINDICATED in this setting?

• A IV normal saline fluid challenge
• B Dopamine infusion for refractory hypotension
• C Temporary pacemaker for complete heart block
• D Nitrates for chest pain relief ✓

Explanation

Right ventricular infarction (RVI) typically complicates inferior STEMI (RCA territory) and presents with hypotension, elevated JVP, and clear lungs (Kussmaul's sign). The RV becomes preload-dependent; vasodilators such as nitrates and diuretics are strictly contraindicated as they reduce preload, causing severe hemodynamic collapse. Management centers on aggressive IV fluids (saline loading), vasopressors (dopamine/norepinephrine) for refractory hypotension, and pacing for heart block. Reperfusion (PCI) of the RCA is the definitive treatment.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.