Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of substernal chest pressure associated with diaphoresis, nausea, and lightheadedness. Symptoms are consistent with inferior wall myocardial infarction. High clinical suspicion for right ventricular (RV) involvement given the presence of hypotension and clear lung fields on auscultation. No history of recent PDE-5 inhibitor use.
Clinical Examination Findings
Vitals: Hypotension noted (SBP < 90 mmHg), tachycardia, and jugular venous distension (JVD). Cardiovascular: S1/S2 present, no murmurs, gallops, or rubs. Pulmonary: Lungs clear to auscultation bilaterally, no crackles or wheezing. Extremities: No peripheral edema. Skin: Cool and clammy, delayed capillary refill.
Treatment Protocol
Immediate management: Establish large-bore IV access. Administer isotonic saline bolus (250-500 mL) to optimize RV preload. Avoid nitrates, morphine, and diuretics due to risk of precipitating severe hypotension. Initiate dual antiplatelet therapy (DAPT) and anticoagulation per ACS protocol. Urgent reperfusion therapy via primary PCI is indicated.