Question

A 68-year-old man presents to the emergency department with 2 hours of crushing retrosternal chest pain radiating to his left arm and jaw, associated with diaphoresis and nausea. He has a history of hypertension and dyslipidaemia. ECG shows 3 mm ST-segment elevation in leads II, III and aVF with reciprocal ST depression in I and aVL. What is the most appropriate immediate management step?

Accepted Answer

Administer acetylsalicylic acid, activate the catheterisation laboratory for primary percutaneous coronary intervention and prepare for urgent reperfusion.

Answer

Give sublingual nitroglycerin and observe for 30 minutes to see if pain resolves.

Answer

Arrange a troponin test and await the result before making further decisions.

Answer

Start a heparin infusion and schedule elective coronary angiography within the next week.

Answer

Give intravenous morphine only, as reperfusion is not indicated until 12 hours after symptom onset.

Practice question