AAAAA
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A 72-year-old man is evaluated for resting chest pain, occurring over the course of the day but also at night related to dreaming. He arrives at the emergency department at 10 AM, 2 hours after the onset of chest pain. He has hyperlipidemia and smokes cigarettes occasionally. His medications consist of an angiotensin-converting enzyme inhibitor, aspirin, and a statin. His brother underwent coronary artery bypass grafting last year.
On examination, the blood pressure is 185/95 mm Hg, heart rate 95/min, with no jugular vein distention, clear lungs, a faint S1, S2, and S4 and an early systolic murmur at the upper right sternal border. Examination of the abdomen and extremities is normal. The resting electrocardiogram is shown (;" name=tip tip="[img>'../figures/thumbs/mk14_a_cv_mcq_f049.jpg'/[/img]] Figure 49). Laboratory studies show normal hematology findings and a serum creatinine of 1.6 mg/dL (141.47 μmol/L), blood urea nitrogen of 29 mg/dL (10.36 mmol/L), and normal electrolytes.
Which of the following is the most appropriate next therapy?
A Fibrinolysis B Coronary angiography C Nitroprusside D Abciximab E Hydralazine
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| amirhossein
Forum Guru
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I cannot see the EkG. But I think the patient has an MI and it is on the left side because of early systolic murmur (probably MR). He has also Malignant Hypertension, coz the BUN and Cr is increasing. We cannot have him for fibrinolysis, coz the BP is over 180 mmHg and he is not now a candidate for angiography. We should do something for BP, so I give him Nitroprusside instead of hydralazine to prevent further damage to kidneys. No place for abciximab, first should trat high maignant BP.
So, my choice is C.
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| Dr.D
Forum Senior
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First lower the BP, then proceed for A
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