Acute myocardial infarction: The Daily PANCE Blueprint
A 60-year-old male with a history of tobacco abuse and diabetes presents to the ER with crushing chest pain. EKG demonstrates ST elevations in the anterior leads. Which of the following is the preferred management?
A. Antiplatelet therapy only
B. Percutaneous coronary intervention
C. Systemic fibrinolytic therapy
D. Start dobutamine and diuretics
E. Admit for a chemical stress test
Answer and topic summary
The answer is B. Percutaneous coronary intervention
A myocardial infarction (MI) is defined as acute ischemic necrosis of myocardial tissue. A Type I MI is due to acute coronary thrombosis or atherosclerotic plaque disruption. There are a few more types as well. Clinical features include chest pain (dull/squeezing), diaphoresis, shortness of breath, new murmur, nausea/emesis, abdominal pain, bradycardia, and dizziness. Work-up should include a 12-lead EKG, troponin, chest X-ray, CBC, CMP, BNP, urine drug screen, and echocardiogram. All patients with suspected acute coronary syndrome should be considered for revascularization with percutaneous coronary intervention (PCI). Anti-platelet and anticoagulation should be given as well, considering no contra-indications. Beta-blockers, ACE/ARBs, and statins are also indicated and given usually within a 24-hour period if there are no contraindications.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Cardiology ⇒ ⇒
Also covered as part of the Internal Medicine EOR, Family Medicine EOR, and Emergency Medicine EOR topic lists
