A 71-year-old man presented with central chest pain which started 10 hours ago. He has a past medical history of hypertension and hyperlipidemia. An ECG demonstrates ST elevation in leads II, III and aVF. Troponin is elevated. He is given 300mg of aspirin and sublingual glyceryl trinitrate. The nearest hospital that can offer primary percutaneous coronary intervention (PCI) is 3 hours away. What is the most appropriate next step?
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الإجابة: A. Administer fibrinolysis
This is an inferior STEMI with symptoms for 10 hours (<12 h). The nearest PCI centre is 3 hours away, so primary PCI cannot be done within 120 minutes of first medical contact; the indicated reperfusion is fibrinolysis, ideally within 30 minutes of arrival. Transferring for PCI (C) would exceed the 120-minute window, heparin alone is not reperfusion, and rechecking troponin only delays treatment.
ليش كل خيار صح أو غلط
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A
ليش صح
STEMI with symptoms under 12 hours and PCI not available within 120 minutes (here 3 h away) means fibrinolysis, given within 30 minutes of arrival.
✓ Step-Up To Medicine 6th (IHD & ACS).pdf · p. 16 -
B
ليش غلط
Heparin is only an adjunct (anticoagulant step of the drug bundle). It is not reperfusion, which he still needs.
✓ CARDIOLOGY- ISCHEMIC HEART DISEASES (IHDs).pdf · p. 10 -
C
ليش غلط
Primary PCI should be done ideally within 90 min and not exceed 120 min of first contact; a 3-hour transfer breaks this, which is the indication for fibrinolysis.
✓ CARDIOLOGY- ISCHEMIC HEART DISEASES (IHDs).pdf · p. 10 -
D
ليش غلط
In STEMI you do not wait for repeat tests: the approach is to initiate therapy without delaying revascularization, and troponin is already raised.
✓ CARDIOLOGY- ISCHEMIC HEART DISEASES (IHDs).pdf · p. 10
- المصدر
- CARDIOLOGY- ISCHEMIC HEART DISEASES (IHDs).pdf · p. 10
Step-Up To Medicine 6th (IHD & ACS).pdf · p. 16 - المحاضرة
- Acute Coronary Syndrome · Cardiology · Module B
- ظهر في
- Cardio bank · MED42 Compre B · MED42 ♂ EOM B