Question

A 67-year-old man presents to a small rural emergency department 45 minutes after the onset of severe central chest pain radiating to his left arm, associated with diaphoresis and nausea. ECG shows 3 mm ST elevation in leads V2-V4. The nearest PCI-capable centre is 3 hours away by road and 90 minutes by retrieval service. What is the most appropriate immediate reperfusion strategy?

Accepted Answer

Administer thrombolysis with tenecteplase as soon as possible and arrange transfer to a PCI centre

Answer

Arrange urgent transfer for primary PCI without reperfusion while awaiting retrieval

Answer

Administer aspirin, clopidogrel and commence unfractionated heparin but withhold reperfusion because presentation is <2 hours

Answer

Commence glyceryl trinitrate infusion and observe for 6 hours

Answer

Give high-dose statin and arrange outpatient cardiology review within one week

Practice question