Question

A 63-year-old man presents to the emergency department with central chest pain for 45 minutes at rest. His ECG shows 2 mm ST elevation in leads II, III and aVF. He lives in a rural town; the nearest PCI-capable centre is 3 hours away by road and no retrieval aircraft is immediately available. It is now 60 minutes since onset of pain. What is the most appropriate reperfusion strategy?

Accepted Answer

Administer fibrinolytic therapy immediately and arrange transfer to a PCI centre afterwards

Answer

Arrange urgent transfer to the PCI centre without fibrinolysis as PCI is the preferred strategy

Answer

Wait 60 more minutes to see if the pain settles before deciding on reperfusion

Answer

Give dual antiplatelet therapy and therapeutic enoxaparin but no reperfusion because the window has passed

Answer

Commence a glyceryl trinitrate infusion and observe in the local hospital overnight

Practice question