A 58-year-old man arrives with 45 minutes of crushing substernal chest pain and diaphoresis. Triage acuity is ESI 2; BP 146/88 mm Hg, HR 96/min, SpO2

Question

A 58-year-old man arrives with 45 minutes of crushing substernal chest pain and diaphoresis. Triage acuity is ESI 2; BP 146/88 mm Hg, HR 96/min, SpO2 97% on room air. ECG shows 2-mm ST elevation in II, III, and aVF with reciprocal ST depression in I and aVL. No fibrinolytic contraindications are present, and PCI is available within 60 minutes. Which of the following is the most appropriate next step in management?

Accepted Answer

Activate the catheterization laboratory for emergent primary PCI

Answer

Schedule coronary CT angiography after pain control

Answer

Begin IV nitroglycerin and repeat the ECG in 2 hours

Answer

Administer IV heparin and observe serial troponins

Answer

Give fibrinolysis before contacting interventional cardiology

ST-elevation myocardial infarction — ABEM Board MCQ