Date Published

January 9, 2024

Updated For

ALS PCS Version ALS PCS Version 5.2


When we do a 12-lead and have inferior involvement, the directive states that we assume there is right sided ventricular MI and must confirm with V4R, and then states we should never give nitro for right sided ventricular STEMI. All of that is clear, but what I am wondering is that if the V4R is negative, does that clear the pt for Nitroglycerin use for the inferior STEMI, or does that simply help confirm the STEMI for the emergency department? Thanks. 


The V4R lead is the most anatomic specific to the Rt ventricle. If the right ventricle is involved, they may be preload dependent and may develop severe hypotension with nitrate administration. Therefore, these patients are contraindicated for nitro prehospital. 



Cardiac Ischemia, Contraindicated, Inferior STEMI, Nitro, Nitroglycerine, Preload Dependent, Right Ventricle, RVI, STEMI

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