A man with inferior ST elevation has a blood pressure of 80/50 mmHg, a raised jugular venous pressure and clear lungs. What is the best initial management?
Answer and explanation
Correct answer: C. Suspect right ventricular infarction: give intravenous fluid, avoid nitrates and arrange reperfusion
- Step 1: Hypotension with raised venous pressure and clear lungs after an inferior infarct indicates right ventricular involvement. Step 2. The right ventricle depends on preload, so nitrates and diuretics can cause collapse, while fluids and reperfusion help. Answer: Intravenous fluid, avoid nitrates, reperfusion. Why not the others: Nitrates and diuretics reduce the preload. The lungs are clear, so there is no pulmonary oedema. Beta blockers worsen shock.
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