Cardio exam

A 60-year-old male presents to the emergency department with crushing chest pain for the last 1.5 hours. ECG shows ST-segment elevation in leads II, III, and aVF. You are working in a hospital without immediate access to a cardiac catheterization lab. Which of the following is the most appropriate immediate therapy for this patient?

• Administer thrombolytic therapy immediately
  
  
  

• Initiate conservative management with oxygen and nitrates, and observe for 24 hours

• Administer intravenous beta-blockers to control heart rate

• Start dual antiplatelet therapy (Aspirin and Clopidogrel) and wait for symptom resolution

Which of the following statements regarding Primary Percutaneous Coronary Intervention (PCI) is TRUE?

• Primary PCI is preferred over thrombolysis if it can be performed within 120 minutes of first medical contact
  
  

• Thrombolysis is always superior to PCI in treating STEMI

• Primary PCI is contraindicated in patients over 65 years old

• Thrombolytics must always be administered before PCI, regardless of time delays

Which of the following is a mechanism of action of thrombolytic agents in the treatment of acute myocardial infarction (MI)?

• Blocking the binding of thrombin to its receptor

• Dissolution of the fibrin clot by activating plasminogen

• Inhibition of factor Xa in the coagulation cascade

• Inhibition of vasoconstriction in coronary arteries

What is the main advantage of primary PCI over thrombolysis in the treatment of STEMI?

• Shorter hospital stay post-intervention

• Higher survival rates and lower risk of recurrent ischemia

• Lower risk of major bleeding complications

• Increased likelihood of arrhythmias post-intervention

In which of the following situations is thrombolytic therapy contraindicated?

• Patient presents within 3 hours of symptom onset

• Patient has a history of diabetes mellitus

• Patient has uncontrolled hypertension with blood pressure of 190/120 mmHg

• Patient has an ST-elevation myocardial infarction (STEMI)

A 58-year-old male presents to the emergency department 3 hours after experiencing chest pain. ECG reveals ST-segment elevation in the anterior leads. He is given aspirin, clopidogrel, and a thrombolytic agent. Which of the following is the most common complication of thrombolysis in this patient?

• Ventricular arrhythmias

• Renal failure

• Heart failure

• Hemorrhagic stroke

Which of the following is NOT a contraindication to thrombolytic therapy in STEMI?

• History of peptic ulcer disease

• Known intracranial neoplasm or aneurysm

• Uncontrolled hypertension (>180/110 mmHg)

• Recent ischemic stroke within 3 months

A 55-year-old woman is diagnosed with a STEMI and receives thrombolytic therapy within 2 hours of symptom onset. After 90 minutes, repeat ECG shows no significant improvement in ST-segment elevation, and she continues to experience chest pain. What is the most appropriate next step?

• Administer a second dose of thrombolysis

• Perform rescue PCI immediately

• Initiate conservative management with antiplatelets

• Discharge the patient for outpatient follow-up

A 58-year-old man presents to the emergency department with severe chest pain that radiates to his back. His blood pressure is 190/110 mmHg, and he has a history of untreated hypertension. A chest X-ray shows a widened mediastinum. What is the most likely diagnosis?

• Acute myocardial infarction

• Aortic dissection

• Pulmonary embolism

• Tension pneumothorax

A 60-year-old male presents to the emergency department with central chest pain and diaphoresis for 2 hours. His ECG shows ST-segment elevation in leads V2-V4, and he is diagnosed with a STEMI. He receives thrombolytic therapy. Which of the following is the most common complication of thrombolysis?

• Ventricular arrhythmias

• Reinfarction

• Heart block

• Intracerebral hemorrhage