WBR0360
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| Author | Neeraja Danda M.B.B.S |
|---|---|
| Exam Type | USMLE Step 2 CK |
| Main Category | Internal medicine |
| Sub Category | Cardiovascular |
| Prompt | A 52 year old male with hypertension and Diabetes presents to the emergency department with severe crushing chest pain that developed when he was watching his favorite show on TV. Electrocardiogram shows ST segment depression in V2-V4.Oxygen, Morphine and nitrates are administered along with aspirin. Heparin and Abciximab are administered thereafter. Patient continues to be in pain and electrocardiogram now shows ventricular tachycardia.What is the next best step in managing this patient? |
| Answer A | Procainamide |
| Answer A Explanation | Incorrect Procainamide is the treatment of choice in wolf Parkinson white Syndrome where supra ventricular tachycardia alternates with ventricular tachycardia. |
| Answer B | Thrombolysis |
| Answer B Explanation | Incorrect Thrombolysis is never the treatment option in ST segment depression or Non ST elevation myocardial infarction |
| Answer C | Coronary artery bypass grafting |
| Answer C Explanation | Incorrect Coronary artery bypass grafting is done if major stenosis is observed in two or three vessels in heart , it’s not the right choice here. |
| Answer D | Percutaneous coronary angiography |
| Answer D Explanation | If a patient develops ventricular tachycardia or experiences continued chest pain following proper medical treatment for ST depression MI, percutanteous coronary angioplasty is the best option |
| Answer E | Digoxin |
| Answer E Explanation | Incorrect Digoxin has no use in Ventricular tachycardia. |
| Right Answer | D |
| Explanation | If a patient develops ventricular tachycardia or experiences continued chest pain following proper medical treatment for ST depression MI, percutanteous coronary angioplasty is the best option.
Educational Objective: If a patient develops ventricular tachycardia or experiences continued chest pain following proper medical treatment for ST depression MI, percutanteous coronary angioplasty is the best option. References: Page 70,71 ,560 Master the boards Step 2 Ck second edition, Page 74 Master the boards Step 3 2009 edition |
| Approved | Yes |
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