Cardiac Medicine Certification (CMC) Practice Exam

During an inferior wall MI, which symptoms might be expected if right ventricular involvement occurs?

1. Hypertension and tachycardia

2. Bradycardia and hypotension

3. Arrhythmias and hypertension

4. Hypotension without bradycardia

The correct answer is: Bradycardia and hypotension

In the context of an inferior wall myocardial infarction (MI), right ventricular involvement can lead to specific hemodynamic changes due to the compromised blood flow and function of the heart. One of the hallmark features of right ventricular MI is a decrease in cardiac output, which often results in bradycardia and hypotension. Bradycardia can occur because of increased vagal tone, which is likely stimulated by the inferior wall ischemia and might lead to a lower heart rate. Hypotension arises because the right ventricle's ability to pump blood effectively is impaired, causing a decrease in the systemic blood pressure. These changes can be particularly pronounced in the setting of an inferior wall MI that also affects the right side of the heart, as the right ventricle plays a crucial role in effective filling and pumping of blood into the pulmonary circulation. Understanding the normal physiological responses to right ventricular involvement during an inferior wall MI is pivotal for recognizing and managing the patient appropriately. This context makes it clear why bradycardia and hypotension are expected symptoms in this scenario.