A 58-year-old man presents to the emergency department with acute chest pain and is found to have the ECG pattern shown in the diagram marked as **B** (inferior STEMI with V4R ST elevation indicating RV infarction). On examination, he has a blood pressure of 88/56 mmHg, jugular venous distension with a paradoxical rise on inspiration, and clear lung fields on auscultation. Which of the following is the MOST appropriate initial management for this patient's hemodynamic instability?
A 62-year-old man with type 2 diabetes, hypertension, and tobacco use presents with 90 minutes of crushing substernal chest pain, diaphoresis, and nausea. On examination, blood pressure is 78/48 mmHg, heart rate 52 bpm, JVP elevated to 12 cm with Kussmaul sign, and lung fields are clear. A standard 12-lead ECG shows ST elevation in leads II, III, and aVF (III > II) with reciprocal changes in I and aVL. A right-sided ECG is obtained. The finding marked **B** in the diagram — ST elevation ≥1 mm in lead V4R with concurrent inferior ST elevation — is the most specific ECG indicator for which diagnosis?
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