Coronary Artery Disease - STEMI Case #8

A 52-year-old male presents with chest pain radiating to his jaw accompanied by shortness of breath and diaphoresis for the past 1 hour. He is afebrile with a blood pressure of 150/100 mm Hg, heart rate of 70 beats per minute, respirations 20 per minute and oxygen 94% on room air. Physical examination reveals normal jugular venous pressure, or JVP, an S4 heart sound and clear lungs. Chest X-ray is normal. Laboratory evaluation is normal, except for a minimally-elevated troponin I. His ECG is below:

PosteriorMI

Which of the following is the appropriate treatment?

A. Aspirin, unfractionated heparin, clopidogrel, beta-blocker, oxygen, nitrates for chest pain and emergent cardiac catheterization with a goal door-to-balloon time of less than 90 minutes

B. Aspirin, unfractionated heparin, clopidogrel, beta-blocker, oxygen, nitrates for chest pain and cardiac catheterization the following day

C. Aspirin, unfractionated heparin, clopidogrel, beta-blocker, oxygen, nitrates for chest pain and further risk stratification with myocardial perfusion imaging to determine the need for catheterization if no complications arise

D. Aspirin, unfractionated heparin, clopidogrel, beta-blocker, oxygen, and nitrates for chest pain

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