In the setting of an inferior wall myocardial infarction extending to the right ventricle (V4R), what resuscitation measure is appropriate to address preload?

• A. Administer fluid bolus
• B. Administer diuretics
• C. Withhold fluids
• D. Administer vasopressin

Answer: (A)

The key idea is preload-dependent hemodynamics from a right ventricular infarction. When the right ventricle is damaged, its ability to fill and pump is reduced, so maintaining or increasing preload helps boost right-sided blood flow and overall cardiac output. Administering a fluid bolus raises venous return to the right heart, improving RV filling and stabilizing blood pressure and perfusion. Diuretics would lower circulating volume and worsen hypotension; withholding fluids deprives the RV of the preload it needs; vasopressors like vasopressin don’t directly improve preload and can raise afterload, potentially harming RV performance. So a cautious IV fluid bolus is the appropriate measure to address preload in this scenario.