A 35-year-old man presents to the ED with severe central chest pain and a systolic blood pressure of 78 mmHg. He is diaphoretic and looks unwell. His ECG shows ST elevation in leads II, III, and aVF. Talk me through your management. | Interview Prep | Job Clerk
A 35-year-old man presents to the ED with severe central chest pain and a systolic blood pressure of 78 mmHg. He is diaphoretic and looks unwell. His ECG shows ST elevation in leads II, III, and aVF. Talk me through your management.
Tips to guide your answer
- Inferior STEMI: ST elevation in II, III, aVF (right coronary artery territory)
- If hypotensive with inferior STEMI, obtain right-sided ECG leads (V4R) to look for RV infarction
- RV infarction: avoid nitrates and diuretics; patient is preload-dependent - give IV fluids