USMLE Step 3 - Question 14

An 48 year old male with a history of hypertension presents to the emergency room with chest pain. He is diaphoretic and short of breath. His temperature is 37.1 C, blood pressure 120/82, heart rate 82, and respirations 20. His physical examination is significant for an S4 heart sound. ECG reveals an inferior wall ST elevation myocardial infarction and appropriate treatment is undertaken. He is discharged home and was doing well. Two months later he develops a sharp chest pain worse with laying flat radiating to his left neck. He returns to his cardiologist and his temperature is 38.5 C, blood pressure 118/82, heart rate 80, and respirations 18. Physical examination is normal. ECG reveals ST segment elevation in leads I, II, III, aVF, aVL, and V1-V4 as well as PR depression in lead II. What is the best treatment at this time?

A. Intravenous heparin

B. Ibuprofen

C. Coronary angiogram

D. Prednisone