dimps
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Q A 55 year old woman presents to the ER because of chest pain .The pain ,which has lasted 3 hrs ,is substernal & dull in nature ,with no relation to respiration or position .The pain does not radiate & is accompanied by weakness ,lightheadedness & nausea .She has recieved oxygen ,aspirin ,a continuous infusion of nitroglycerine & a beta blocker .Her chest xray is normal & her ECG is remarkable for inverted T waves in lead ii ,iii,& avF .which of the following is the most important next step in management.?
a..nifedipin
b..iv heparin
c..iv thrombolytic therapy
d..cardiac catheterization
e..PTCA
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| tasneembanu
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is it C ?
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| dr.shar
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b..iv heparin
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| merrk
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b
Indication for thrombolysis include 2 of the foll 3
1. chest pain >20min
2. ST elevation of 1mm in 2 conseq leads or new onset BBB
3. Elevated cardiac enzymes
the question only mentions 1.... chest pain so i dont think we can thrombolyse her
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| mocherla
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Mocherla
Could it be d ???
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| son64
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It is B.
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| tuesday
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B.... IV heparin. to prevent thrombus formation. pt. is obviously having an AMI
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| mnhakeem
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Persistence pain after vasodilator is indication of Catheterization
so d is the answer
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| dimps
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this Q is from Q book pg 73...they say it is unstable angina & so answer is B..heparin
but can anybody explain is this condition unstable angina or MI
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| mnhakeem
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u r right b is the answer
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| tuesday
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this is unstable angina bec. of the presntn.. plus ekg findings w/c in this case is t wave inversion. Pt. is forming a clot that's why he needs heparin.
In MI, above sxs. , EKG is ST elevation but a clot has been formed so thrombolytics are needed to lyse the thrombus.
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| Drmos
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answer is heparin....
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| mdwannabe
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st depression..and flip T's are indications of ongoing ischemia. usually subendocardial in origin.
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