Coronary Artery Disease - STEMI Case #7

A 40-year-old female with no past cardiovascular medical history presents to the ED with acute onset chest pain radiating to the back. She is short of breath, nauseated and diaphoretic. She is afebrile with a blood pressure of 80/40 mm Hg, heart rate of 100 beats per minute and respirations 24 per minute. Her lungs are clear. Heart exam reveals a II/IV short early diastolic murmur at the right upper sternal border and an S4 heart sound. Her radial pulse is absent on the left and normal on the right, and the pulsus paradoxus is 10 mm Hg. Her ECG is below:


Which of the following is the appropriate treatment?

A. Emergent cardiac catheterization and primary percutaneous coronary intervention

B. Anticoagulation with unfractionated heparin and supportive care

C. Pericardiocentesis

D. Emergency cardiac surgery