ST-elevation myocardial infarction — CCFP MCQ

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HardEmergency presentations in communityST-elevation myocardial infarctionCCFP

A 61‑year‑old man phones your rural clinic with 45 minutes of central chest pressure radiating to the left arm. He is diaphoretic and nauseated. The clinic ECG shows 3 mm ST‑elevation in leads II, III and aVF. The nearest PCI centre is 3 hours away by road. What is the most appropriate next step in management?

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Correct answer: E — Activate emergency transfer and arrange reperfusion via regional STEMI protocol

Explanation lettering: E = shown as A · A = shown as C · C = shown as D · D = shown as E

The correct answer is **D**. The patient’s presentation—classic chest pressure, diaphoresis, nausea, and diagnostic ST‑elevation in inferior leads—confirms acute STEMI. In rural Canada with anticipated transfer delays of 3 hours, the 2019 CCS/CAIC guidelines advise activation of organized regional STEMI networks to expedite reperfusion, potentially using pharmacoinvasive strategies if primary PCI cannot be achieved timely ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/30760415/?utm_source=openai)). For community hospital presentations, studies show transfers are often delayed and on‑site fibrinolysis may be appropriate based on anticipated door‑to‑balloon times ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/17932588/?utm_source=openai)). Distractors are all inappropriate: A delays urgent treatment; B misattributes symptoms to reflux despite diagnostic ECG; C is contraindicated in acute MI; E is irrelevant to the presentation.

Reference: Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology (2019) – Guidelines on the Acute Management of ST‑Elevation Myocardial Infarction: Focused Update on Regionalization and Reperfusion – https://pubmed.ncbi.nlm.nih.gov/30760415/