Question

A 62-year-old man presents to a small rural emergency department with 2 hours of crushing central chest pain radiating to his left arm. His ECG shows 3 mm ST elevation in leads V2-V4 with reciprocal ST depression in leads III and aVF. The nearest PCI-capable hospital is 200 km away with an anticipated first-medical-contact-to-balloon time of about 3 hours despite immediate transfer. He has no history of bleeding, no recent stroke, and normal baseline bloodwork. Which reperfusion strategy is most appropriate now?

Accepted Answer

Administer fibrinolytic therapy immediately and arrange transfer for coronary angiography within 24 hours

Answer

Arrange immediate transfer for primary PCI without fibrinolysis

Answer

Wait to see if the pain settles with nitrates and repeat the ECG in 2 hours

Answer

Start dual antiplatelet therapy only and arrange outpatient stress testing

Answer

Refer directly for urgent coronary artery bypass grafting without prior reperfusion

Practice question