Which finding is most consistent with right ventricular infarction during an inferior MI?

• A. Hypotension with clear lungs
• B. Pulmonary edema
• C. JVD with crackles
• D. Hypertension

Answer: (A)

During an inferior myocardial infarction, involvement of the right ventricle can cause the RV to fail at delivering blood to the lungs. That reduces the amount of blood returning to the left ventricle (decreased LV preload), which lowers systemic blood pressure. Since the left ventricle isn’t being overloaded, the lungs aren’t congested, so they stay clear. This combination—low blood pressure with clear lungs—is the hallmark of right ventricular infarction.

Pulmonary edema would indicate fluid backing up into the lungs from left-sided failure, not typical of an isolated right-sided problem. A finding of JVD with crackles could suggest venous congestion but crackles imply pulmonary edema, which again points away from a pure RV infarct. Hypertension is not expected because the RV infarct reduces forward flow and systemic perfusion.