Arab Board IM Final Written Practice Questions - Arab Board Internal Medicine Final Written Examination Exam

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A 64-year-old man presents with recurrent episodes of retrosternal chest pressure occurring at rest over the past 12 hours. His ECG shows 1.5-mm horizontal ST-segment depression in leads V4 through V6 and T-wave inversion in lead aVL. High-sensitivity cardiac troponin I is elevated at 480 ng/L (reference < 14 ng/L). His calculated GRACE risk score is 158. He is hemodynamically stable with a blood pressure of 135/85 mmHg and a heart rate of 76 bpm. Which of the following is the most appropriate next step in management?

Early invasive coronary angiography within 24 hours Immediate intravenous thrombolytic therapy with tenecteplase Outpatient exercise treadmill stress electrocardiography Elective myocardial perfusion scintigraphy in 4 to 6 weeks

Correct Answer:

Early invasive coronary angiography within 24 hours

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