Question

A 62-year-old man presents to the emergency department with 1 hour of central crushing chest pain radiating to his left arm, associated with diaphoresis and nausea. ECG shows ST elevation in leads V2-V5. He received 300 mg aspirin from paramedics. Emergent percutaneous coronary intervention (PCI) has been arranged within 60 minutes. What is the most appropriate additional immediate pharmacological management?

Accepted Answer

Give a loading dose of a P2Y12 inhibitor (such as ticagrelor) plus parenteral anticoagulation before PCI

Answer

Administer intravenous thrombolysis with tenecteplase while awaiting PCI

Answer

Give sublingual glyceryl trinitrate and high-flow oxygen, but no further antiplatelet therapy before angiography

Answer

Start an intravenous beta blocker infusion to reduce heart rate and blood pressure

Answer

Commence an ACE inhibitor immediately and titrate to maximum tolerated dose in the emergency department

Practice question