A 58-year-old woman has a 3-hour history of chest pain, diaphoresis, and shortness of breath. Her medical history is significant for T2DM, hypertension and dyslipidemia. On examination, HR 50/min, BP 125/60 mmHg, and oxygen saturation is 98% on room air, she has no jugular venous distention, and her lungs are clear. ECG shows ST segment elevation and T wave inversion in leads ll, Ill and aVF. Troponin is elevated. The nearest hospital capable of percutaneous coronary intervention is three hours away. Which of the following is the most appropriate initial management 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: C. Aspirin, heparin, clopidogrel, intravenous nitroglycerin, and thrombolytic therapy
Inferior STEMI (ST elevation II, III, aVF) with the nearest PCI centre 3 hours away: PCI cannot be done within 120 minutes, so give fibrinolysis (symptoms <12 h) plus dual antiplatelet therapy (aspirin + clopidogrel) and heparin. Option D wastes time (transfer >120 min). Option A lacks a P2Y12 inhibitor and gives IV metoprolol to a patient who is already bradycardic (HR 50), common in inferior MI. Option B has no aspirin and no reperfusion.
ليش كل خيار صح أو غلط
-
A
ليش غلط
Includes IV metoprolol, but inferior MI often presents with sinus bradycardia (her HR is 50), so this combination is unsuitable.
✓ CARDIOLOGY- ISCHEMIC HEART DISEASES (IHDs).pdf · p. 8 -
B
ليش غلط
It has no reperfusion (PCI is over 120 min away, so fibrinolysis is indicated) and omits aspirin, which is indicated in MI.
✓ Step-Up To Medicine 6th (IHD & ACS).pdf · p. 16 -
C
ليش صح
Symptoms under 12 h and PCI not available within 120 min call for fibrinolysis, with the MI drugs (aspirin, P2Y12 inhibitor, nitroglycerin, heparin).
✓ Step-Up To Medicine 6th (IHD & ACS).pdf · p. 16 -
D
ليش غلط
PCI is preferred only if it can be done within 120 minutes; at 3 hours away, transfer alone is not the right choice.
✓ Step-Up To Medicine 6th (IHD & ACS).pdf · p. 16
- المصدر
- Step-Up To Medicine 6th (IHD & ACS).pdf · p. 16
Step-Up To Medicine 6th (IHD & ACS).pdf · p. 15 - المحاضرة
- Acute Coronary Syndrome · Cardiology · Module B
- ظهر في
- Cardio bank