If ST elevation is noted in inferior leads, what additional step should be taken?

If ST elevation is noted in inferior leads, what additional step should be taken?

• A. Call for CT angiography
• B. Administer aspirin
• C. Obtain V4R lead
• D. Administer nitroglycerin

Answer: (C)

When inferior-STEMI is suspected, check for right ventricular involvement because it significantly changes treatment. Right ventricular infarction often accompanies an inferior wall MI from RCA occlusion, and detecting it early guides hemodynamic management. Obtaining a right‑sided ECG lead, especially V4R, can reveal ST elevation there if the RV is involved. A positive V4R confirms RV infarction, which means nitrates should be avoided since they reduce preload and can cause dangerous hypotension in RV infarct; treatment then focuses on maintaining preload (often with IV fluids) while continuing urgent reperfusion. CT angiography would not be the immediate step in acute STEMI care and could delay reperfusion. Administering aspirin is important in STEMI, but it doesn’t specifically address whether the RV is involved. Administering nitroglycerin is risky if there is RV infarction, because it can worsen preload-dependent hemodynamics. Identifying RV involvement with the V4R lead is the best next action to tailor therapy.

When inferior-STEMI is suspected, check for right ventricular involvement because it significantly changes treatment. Right ventricular infarction often accompanies an inferior wall MI from RCA occlusion, and detecting it early guides hemodynamic management. Obtaining a right‑sided ECG lead, especially V4R, can reveal ST elevation there if the RV is involved. A positive V4R confirms RV infarction, which means nitrates should be avoided since they reduce preload and can cause dangerous hypotension in RV infarct; treatment then focuses on maintaining preload (often with IV fluids) while continuing urgent reperfusion.

CT angiography would not be the immediate step in acute STEMI care and could delay reperfusion. Administering aspirin is important in STEMI, but it doesn’t specifically address whether the RV is involved. Administering nitroglycerin is risky if there is RV infarction, because it can worsen preload-dependent hemodynamics. Identifying RV involvement with the V4R lead is the best next action to tailor therapy.