A 54-year-old woman has an intermittent jaw, and shoulder pain for the past week. The symptoms occur with activity and are relieved by rest. On physical examination, BP 150/68 mmHg and HR 90/min. There is no jugular venous distention or cardiac murmurs. Lung fields are clear, and extremities show no edema. The troponin I level is elevated. Electrocardiogram shows 1.0-mm ST-segment depression in leads V1 through V4 with T-wave inversions. She is given aspirin, intravenous nitroglycerin. low-molecular-weight heparin, clopidogrel, and atorvastatin. Which of the following is the most appropriate additional immediate treatment for this patient?
سؤال مجاني 3 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: D. Metoprolol
Exertional symptoms + elevated troponin + ST depression/T inversion = NSTEMI. She already has antiplatelets, anticoagulant, nitrate and statin; the missing piece of initial therapy is a beta-blocker (metoprolol), given when there is no hypotension or heart failure (she has neither). IV fibrinolysis is not beneficial in UA/NSTEMI (it is for STEMI), and an intra-aortic balloon pump is for cardiogenic shock.
ليش كل خيار صح أو غلط
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A
ليش غلط
An ACE inhibitor is listed among the discharge medicines after MI, not as the missing initial anti-ischaemic drug here.
✓ Step-Up To Medicine 6th (IHD & ACS).pdf · p. 19 -
B
ليش غلط
Fibrinolysis has not been proven beneficial in UA/NSTEMI; it is only for STEMI when urgent PCI is not accessible. This is NSTEMI.
✓ Step-Up To Medicine 6th (IHD & ACS).pdf · p. 17 -
C
ليش غلط
A balloon pump or device support is for severe pump failure and cardiogenic shock; she has clear lungs, no JVD and BP 150/68.
✓ Step-Up To Medicine 6th (IHD & ACS).pdf · p. 17 -
D
ليش صح
A beta-blocker such as metoprolol is given if there is no hypotension or heart failure, and she has neither.
✓ Step-Up To Medicine 6th (IHD & ACS).pdf · p. 14
- المصدر
- Step-Up To Medicine 6th (IHD & ACS).pdf · p. 14
Step-Up To Medicine 6th (IHD & ACS).pdf · p. 17 - المحاضرة
- Ischemic Heart Disease · Cardiology · Module B
- ظهر في
- Cardio bank