Question

A 60-year-old man presents to a metropolitan emergency department 45 minutes after sudden onset of severe central chest pain radiating to his left arm. ECG shows 3 mm ST elevation in V2-V4 with reciprocal ST depression in the inferior leads. Blood pressure is 130/80 mmHg and oxygen saturation is 97% on room air. The hospital has a 24-hour catheter laboratory with expected door-to-balloon time of 60 minutes. What is the most appropriate next step in his management?

Accepted Answer

Administer 300 mg aspirin orally and activate the catheter laboratory for immediate primary PCI

Answer

Administer tenecteplase thrombolysis and plan coronary angiography 24 hours later

Answer

Give sublingual glyceryl trinitrate and arrange an outpatient stress test within a week

Answer

Give morphine and observe with serial troponins and repeat ECGs

Answer

Delay reperfusion until high-sensitivity troponin results are available

Practice question