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    Subjects/Medicine/ECG — Acute Inferior MI with RV Infarction (V4R)
    ECG — Acute Inferior MI with RV Infarction (V4R)
    hard
    stethoscope Medicine

    A 58-year-old man with acute inferior STEMI and ST elevation in leads II, III, and aVF is brought to the catheterization laboratory. Right-sided ECG leads are obtained, revealing ST elevation ≥1 mm in lead V4R, confirming right ventricular infarction. The patient's blood pressure is 88/56 mmHg, JVD is elevated, and lung fields are clear on auscultation. The cardiologist is preparing the acute management strategy marked as **D** in the diagram. Which of the following interventions is CONTRAINDICATED in the acute phase of this patient's presentation?

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