A patient with acute inferior wall MI reports chest pain and dyspnea. Vital signs reveal hypotension with clear lungs. Which development should the nurse suspect?

• A. Pulmonary edema
• B. Atrial fibrillation
• C. Right ventricular infarction causing hypotension and clear lungs
• D. Pericardial tamponade

Answer: (C)

Inferior wall myocardial infarction can involve the right ventricle. When you see hypotension with clear lungs after an inferior MI, think right ventricular infarction. The right ventricle isn’t pumping effectively, so preload to the left ventricle falls and cardiac output drops, causing low blood pressure. Because the left heart isn’t backing up, the lungs aren’t congested, so they remain clear. This pattern helps distinguish RV infarction from left-sided failure, which would usually produce pulmonary edema.

Clinical cues supporting this include signs of right-sided involvement such as hypotension with clear lungs and often elevated jugular venous pressure. Management centers on improving right ventricular preload without overloading the patient: give IV fluids to increase RV filling, avoid nitrates and diuretics that decrease preload, provide oxygen as needed, and monitor for rhythm disturbances or the need for vasopressors if hypotension persists.