Board Review: Cardiology

A 60-year-old man presents with chest pain. His EKG shows ST elevations in leads II, III and aVF as well as ST depressions in V2 and V3. A right-sided electrocardiogram is also performed and shows elevated ST segments in V4R and V5R. Which of the following medications is contraindicated? 

A. Aspirin

B. Nitroglycerin

C. IV fluids

D. Heparin










Answer: B - Nitroglycerin


-always suspect right ventricle infarction in any patient with an inferior STEMI and ask for a right sided EKG. 

-ST elevation in lead III > II. 

-ST depression in V2 and ST elevation in V1. 

-these patients are preload dependant and should be treated with IV fluids for hypotension; nitroglycerin is contraindicated. 

-they can be complicated by high degree AV block.