Eidgenössisches Examen Humanmedizin Practice Questions - Eidgenössische Prüfung In Humanmedizin Examen Fédéral En Médecine Humaine Exam

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A 58-year-old male presents to the emergency department with acute, crushing substernal chest pain radiating to his left arm and jaw that started 45 minutes ago. He is diaphoresis and dyspneic. His 12-lead ECG demonstrates 3 mm ST-segment elevations in leads V1–V4 with reciprocal ST depressions in leads II, III, and aVF. Blood pressure is 135/85 mmHg, heart rate is 88 bpm, and SpO2 is 97% on room air. According to European Society of Cardiology (ESC) guidelines, what is the most appropriate immediate reperfusion and pharmacological strategy?

Immediate transfer for primary percutaneous coronary intervention (PCI) with target wire-crossing <90 minutes, loading with aspirin, a potent P2Y12 inhibitor (ticagrelor or prasugrel), and unfractionated heparin Immediate IV fibrinolysis with tenecteplase in the emergency department followed by routine elective coronary angiography within 48 to 72 hours Immediate administration of high-dose intravenous nitroglycerin, beta-blocker, and fondaparinux, delaying catheterization until high-sensitivity troponin levels peak Immediate transfer for emergent coronary artery bypass grafting (CABG) as first-line revascularization for all anterior ST-segment elevation myocardial infarctions

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