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ST-elevation myocardial infarction — SCE Acute Medicine MCQ

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EasyAcute Cardiac PresentationsST-elevation myocardial infarctionSCE Acute Medicine

A 58-year-old man is assessed on the acute medical unit. He has crushing central chest pain radiating to the left arm. ECG shows 3 mm ST elevation in II, III and aVF with reciprocal anterior ST depression. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: D — Arrange immediate coronary angiography

Arrange immediate coronary angiography is the best answer because ST elevation in a regional pattern with ongoing ischaemic pain requires immediate reperfusion by primary PCI where available. Perform synchronised direct-current cardioversion is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Do not wait for troponin when the ECG already shows STEMI.

Reference: NICE NG185