Question

A 58‑year‑old man presents to 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. There is no access to on‑site PCI; the nearest PCI centre is 4 hours away by road and weather prevents aeromedical transfer. What is the most appropriate reperfusion strategy?

Accepted Answer

Administer thrombolytic therapy immediately and arrange later transfer

Answer

Arrange road transfer to the PCI centre without thrombolysis

Answer

Give dual antiplatelet therapy only and admit locally

Answer

Withhold reperfusion because symptom duration is <12 hours

Answer

Commence heparin infusion only and observe

Practice question