ERES Bonaerense Medicina Practice Questions - Buenos Aires Province Health Residencies Examination (Examen De Residencias Del Sistema De Salud Bonaerense - ERES Medicina) Exam

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A 58-year-old man presents to the emergency department in a provincial hospital in Buenos Aires with 90 minutes of crushing retrosternal chest pain radiating to his left arm and jaw. An immediate 12-lead electrocardiogram (ECG) reveals 3 mm ST-segment elevation in leads V1–V4. The nearest facility with a cardiac catheterization laboratory capable of primary percutaneous coronary intervention (PCI) is 3 hours away. Blood pressure is 135/85 mmHg, heart rate is 82 bpm, and oxygen saturation is 97% on room air. There are no contraindications to thrombolysis. According to Argentine and international acute coronary syndrome guidelines, what is the most appropriate next step in management?
Correct Answer:
Immediate administration of systemic intravenous fibrinolytic therapy (e.g., tenecteplase or alteplase) along with dual antiplatelet therapy and anticoagulation

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