Internat Médecine (Côte D'Ivoire) Practice Questions - Concours National D'Internat Des Hôpitaux En Médecine (Côte D'Ivoire) Exam

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A 54-year-old male with a history of smoking and dyslipidemia presents with crushing substernal chest pain of 90 minutes duration radiating to the left jaw and arm. The 12-lead ECG reveals 3 mm ST-segment elevation in leads V1–V4 with reciprocal ST depression in leads II, III, and aVF. The nearest percutaneous coronary intervention (PCI) center is 4 hours away. What is the correct immediate reperfusion strategy?

Immediate intravenous fibrinolytic therapy (e.g., tenecteplase) within 10 minutes of diagnosis, accompanied by aspirin, clopidogrel, and enoxaparin Transfer for primary PCI regardless of the 4-hour transport delay Conservative medical management with nitrates, beta-blockers, and delayed elective coronary angiography at 48 hours Intravenous unfractionated heparin bolus alone without antiplatelet or fibrinolytic agents

Correct Answer:

Immediate intravenous fibrinolytic therapy (e.g., tenecteplase) within 10 minutes of diagnosis, accompanied by aspirin, clopidogrel, and enoxaparin

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