Question

A 64-year-old man presents to a rural emergency department 60 minutes after onset of crushing central chest pain with diaphoresis. ECG shows 3 mm ST elevation in V2-V4. The nearest percutaneous coronary intervention centre is 3 hours away by ground, with no air transport available due to weather. What is the most appropriate reperfusion strategy?

Accepted Answer

Administer fibrinolytic therapy now and transfer for rescue or routine angiography

Answer

Arrange immediate transfer for primary percutaneous coronary intervention despite the 3-hour delay

Answer

Give dual antiplatelet therapy and observe for spontaneous reperfusion without fibrinolysis

Answer

Delay reperfusion until the weather improves and air transfer becomes available

Answer

Start intravenous heparin alone without reperfusion

Practice question