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Postoperative myocardial injury — SCE Acute Medicine MCQ

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ModeratePerioperative, Safety and End-of-Life CarePostoperative myocardial injurySCE Acute Medicine

A 63-year-old woman presents with postoperative deterioration, treatment refusal or advanced illness. Relevant history includes recent surgery, frailty or a governance issue. On assessment, physiology and communication context require senior decision-making. Investigations show post-laparotomy troponin rise with anaemia and no STEMI. What is the most appropriate next step in management?

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Correct answer: A — Assess triggers and balance ACS treatment with bleeding risk

The key discriminator is that post-laparotomy troponin rise with anaemia and no STEMI, which makes Assess triggers and balance ACS treatment with bleeding risk the single best answer. Start anticoagulation after assessing bleeding risk is less appropriate because it does not address the dominant acute risk in the vignette; Give controlled oxygen and senior review would fit a different presentation or later stage of care. Call critical care for escalation and Start broad-spectrum intravenous antibiotics are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: ESC perioperative cardiovascular guideline; NICE NG185