Question

A 58-year-old man presents with crushing chest pain for 45 minutes. ECG shows 3 mm ST elevation in leads II, III and aVF. There is no access to primary PCI within 120 minutes. According to Canadian and international STEMI guidance, what is the most appropriate immediate management?

Accepted Answer

Administer fibrinolytic therapy promptly and arrange transfer to PCI centre

Answer

Wait for PCI-capable ambulance and withhold reperfusion until arrival

Answer

Start dual antiplatelet therapy only and observe

Answer

Give full-dose low-molecular-weight heparin and arrange elective angiography

Answer

Treat with nitrates alone unless pain persists beyond 90 minutes

Practice question

A 58-year-old man presents with crushing chest pain for 45 minutes. ECG shows 3 mm ST elevation in leads II, III and aVF. There is no access to primary PCI within 120 minutes. According to Canadian and international STEMI guidance, what is the most appropriate immediate management?