A 64 year-old woman complains of continuous chest pain for 20 minutes. It started suddenly during a stressful meeting. Her pain is dull, aching in nature and 9/10 in severity. She had several episodes of chest pain in the past that starting after exertion and resolving by rest. She was diagnosed with type 2 diabetes and hypertension 8 years ago. Her pulse is 98/min., regular and blood pressure is 160/100. ECG shows T inversion in leads II, III and AVF. Cardiac enzymes are negative. Echocardiography shows no wall motion abnormalities and ejection fraction of 65%.
What is the most appropriate immediate treatment of this patient?
B-Tissue plasminogen activator (tPA)
This is a case of unstable angina or NSTEMI confirmed by ECG changes, negative cardiac enzymes and echocardiography. The main course of treatment is anticoagulation as enoxaparin and should be administered as soon as possible. Ibuprofen and other NSAIDs are contraindicated in this case as they increase mortality and morbidity. Thrombolysis as tPA are indicated in elevated ST myocardial infarction. Coronary angioplasty and cardiac catheterization are invasive procedures that not recommended at this time.
The correct answer is C
6 thoughts on “USMLE Q Bank Step 2 CK- 403”
Needs cor angio
Thank you Danclemy
I love this question because it keeps someone researching.
this is NSTEMI bcos of the ECG changes . Unstable angina has normal ECG changes
This is a great question. Unstable angina usually occurs after several episodes of stable angina. ECG shows no changes in stable angina but it shows features of unstable angina in this patient.
She had several episodes of chest pain in the past that starting after exertion and resolving by rest.
Then how can it be unstable angina ?