A patient with confirmed right ventricular infarction (ST-elevation in V4R) in the context of an inferior STEMI develops hypotension after receiving s...

Question

A patient with confirmed right ventricular infarction (ST-elevation in V4R) in the context of an inferior STEMI develops hypotension after receiving sublingual GTN. What is the mechanism of the hypotension and what is the appropriate treatment?

Accepted Answer

GTN reduces preload - the preload-dependent right ventricle cannot maintain cardiac output; treat with IV fluid bolus (250 mL 0.9% saline) and stop GTN

Answer

The patient has developed cardiogenic shock from left ventricular failure - administer IV furosemide

Answer

The patient is having a secondary MI - administer thrombolysis

Answer

GTN has caused a vasovagal response - administer IV atropine

Answer

The GTN has caused an allergic reaction - administer IM adrenaline

uk-dipimc MCQ (SBA): RV Infarction and GTN Hypotension

A patient with confirmed right ventricular infarction (ST-elevation in V4R) in the context of an inferior STEMI develops hypotension after receiving sublingual GTN. What is the mechanism of the hypotension and what is the appropriate treatment?