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Acute coronary syndrome — MCCQE Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

ModerateChest PainAcute coronary syndromeMCCQE Part 1

58-year-old man with diabetes and smoking history presents with central crushing chest pain radiating to the left arm for 45 minutes. He is diaphoretic, BP is 94/60 mmHg and the ECG shows ST elevation in II, III and aVF. Which of the following is the most appropriate next step?

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Reveal the answer and explanation

Correct answer: E — Activate STEMI reperfusion pathway, give acetylsalicylic acid and arrange urgent PCI-capable transfer

Activate STEMI reperfusion pathway, give acetylsalicylic acid and arrange urgent PCI-capable transfer is best because this is an inferior STEMI and reperfusion should be organised immediately while antiplatelet therapy is started. Discharge after a single normal initial test is suboptimal because early cardiac disease can be missed by one isolated result; Arrange routine cardiology review without acute risk stratification is suboptimal because routine referral is too slow for a potentially unstable presentation; Give reassurance because the patient is young or previously well is suboptimal because age alone does not exclude serious cardiovascular disease; Treat only the symptom and omit ECG or biomarker-based assessment is suboptimal because cardiac presentations require objective assessment when suggested clinically. In Canada, STEMI care depends on regional PCI access, but reperfusion should not be delayed.

Reference: CCS STEMI guidance; CCS antiplatelet guideline 2024