Q- 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 started after exertion and resolved 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 an ejection fraction of 65%.
Which of the following is the most appropriate immediate treatment for this patient?
A-Ibuprofen
B-Tissue plasminogen activator (tPA)
C-Enoxaparin
D-Coronary angioplasty
E-Cardiac catheterization
Answer
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 such 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
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 ?