Facharzt FMH Kardiologie Practice Questions - Facharzt FMH Für Kardiologie Spécialiste FMH En Cardiologie Exam

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A 62-year-old woman receives full-dose intravenous tenecteplase for an acute anterior STEMI at a community clinic. Ninety minutes after lytic administration, she reports persistent crushing chest pain (8/10), and repeat ECG reveals less than 20% resolution of the maximal ST-segment elevation in lead V3. What is the mandatory next step in management?

Administer a second full dose of intravenous tenecteplase to achieve complete enzymatic thrombus dissolution. Switch to intravenous bivalirudin infusion and observe the patient in the coronary care unit for 6 hours. Initiate high-dose intravenous nitroglycerin and wait 24 hours for delayed endogenous fibrinolysis. Perform emergent coronary angiography and rescue percutaneous coronary intervention without delay.

Correct Answer:

Perform emergent coronary angiography and rescue percutaneous coronary intervention without delay.

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