ST-Elevation Myocardial Infarction Assignment

ST-Elevation Myocardial Infarction Assignment
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ST-Elevation Myocardial Infarction Assignment
1 A 57-year-old man with hypertension, who is a
current tobacco user, presented to the emergency
department with substernal chest pain. The chest
pain started 90 minutes ago and is associated with
nausea and diaphoresis. A prior electrocardiogram
(EKG)from 1 year ago is shown below and his current
EKG on presentation is shown in the figure in the
next column. On physical examination his blood
pressure (BP) is 146/84, with a pulse of 84 bpm.
His lungs are clear to auscultation. His neck veins
are flat. He has a regular rate and rhythm with no
murmurs, rubs, or gallops. He has 2 pulses in his
distal extremities. He is placed on telemetry and is
given aspirin 325 mg PO, nitroglycerin 0.4 mg SL,
metoprolol 5 mg IV Q5min times three, and started
V1 V4
V2 V5
V3 V6
ST-Elevation Myocardial Infarction Assignment
25mm/s 10mm/mV 150Hz 005E 12SL 237 CID: 12
on an IV unfractionated heparin (UFH) drip. He has
some relief in his chest pain. The most appropriate
next step in this patient’s management should
V1 V4
V2 V5
V3 V6
25mm/s 10mm/mV 005E 12SL 250 CID: 27
(A) Initiation of eptifibatide: 180 µg/kg IV bolus,
followed by an infusion at 2 µg/kg/min IV
(B) Admission to the cardiac care unit for further
monitoring while awaiting results of serial
cardiac biomarkers
(C) Order a single photon emission computerized
tomography (SPECT) radionuclide imaging
stress test to further evaluate the etiology of
the patient’s chest pain
(D) Implement a strategy for early reperfusion
310 900 Questions: An Interventional Cardiology Board Review
2 A 74-year-old woman presented with a posterolateral
ST-elevation myocardial infarction (STEMI). She
underwent emergent coronary angiography and
primary percutaneous coronary intervention (PCI)
of a totally occluded proximal left circumflex
artery with percutaneous transluminal coronary
angioplasty (PTCA) and stenting of the lesion with
a sirolimus-eluting stent. At the conclusion of the
case, the patient was administered an oral 300 mg
loading dose of clopidogrel. On the basis of the
current ACC/AHA guidelines, the most appropriate
antiplatelet regimen at discharge for this patient is:
(A) Aspirin 162 mg PO daily for an indefinite period
of time and clopidogrel 75 mg PO daily for at
least 3 months
(B) Aspirin 162 mg PO daily for at least 12 months
and clopidogrel 75 mg PO daily for at least
3 months
(C) Aspirin 325 mg PO daily for an indefinite period
and clopidogrel 75 mg PO daily for at least
1 month
(D) Aspirin 162 mg PO daily for at least 12 months
and clopidogrel 75 mg PO daily for at least
12 months
ST-Elevation Myocardial Infarction Assignment
3 A 59-year-old woman with a history of hypertension and hypercholesterolemia presented with
chest pain. The EKG demonstrated an inferolateral
STEMI. She underwent early successful reperfusion with the administration of fibrinolytic agents.
Her medications at the time of admission included hydrochlorothiazide, atenolol, simvastatin,
and hormone replacement therapy (HRT) (estrogen/medroxyprogesterone combination pill). She has
been taking HRT for 8 months for perimenopausal
symptoms. In regard to her HRT, the most appropriate recommendation at this time is to:
(A) Continue the HRT indefinitely
(B) Discontinue the HRT indefinitely
(C) Continue the HRT while she is hospitalized, but
discontinue it at discharge
(D) Discontinue the HRT while she is hospitalized,
but continue it at discharge
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