Question

A 59-year-old woman presents to the emergency department of a small rural hospital 3 hours after onset of severe central chest pain. ECG shows 3 mm ST elevation in leads II, III and aVF. The nearest PCI-capable centre is 3 hours away by road, and helicopter transfer is unavailable due to weather. What is the most appropriate reperfusion strategy?

Accepted Answer

Administer intravenous thrombolysis with tenecteplase as soon as possible and arrange transfer after lysis

Answer

Immediate transfer by road to the PCI centre without fibrinolysis

Answer

Start heparin and arrange transfer for angiography the next day without reperfusion

Answer

Observe with serial troponins and repeat ECG in 6 hours

Answer

Administer glyceryl trinitrate only and reassess pain response

Practice question