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ST-elevation myocardial infarction — MCCQE Part 1 MCQ

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EasyChest PainST-elevation myocardial infarctionMCCQE Part 1

A 62-year-old man in Toronto presents with 70 minutes of crushing retrosternal chest pain radiating to the left arm, diaphoresis and nausea. ECG shows 3 mm ST elevation in II, III and aVF; blood pressure is 138/82 mmHg and oxygen saturation is 96% on room air. Which of the following is the most appropriate next step?

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Correct answer: D — Activate emergent reperfusion with primary PCI if it can be performed promptly

This is an inferior STEMI and the priority is immediate reperfusion, preferably primary PCI when available within an appropriate regional time window. Troponin confirmation must not delay reperfusion, and oxygen is reserved for hypoxaemia or respiratory distress. Stress testing and reflux treatment are unsafe because the ECG already establishes an occlusive coronary syndrome.

Reference: CCS acute coronary syndrome guidance; Canadian Cardiovascular Society resources