WBR0991

Author	[[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type	USMLE Step 3
Main Category	Emergency Room
Sub Category	Cardiovascular
Prompt	A 59 year- old male comes to ED complaining of chest pain. The pain started while he was watching TV 30 minutes ago, and radiating to the left shoulder. His pain is dull constant in nature, and it is accompanied by diaphoresis and nausea. EKG is normal, and his Troponin levels are elevated. The patient has been given oxygen, nitrates, morphine, and aspirin. Which of the following is the best next step in managing this patient?
Answer A	Thrombolytic
Answer A Explanation	Incorrect In NSTEMI thrombolytic do not lower mortality. Thrombolytic used only if there is ST segment elevation or a new LBBB within 12 hours of the onset of chest pain.
Answer B	Low molecular weight heparin
Answer B Explanation	Correct In NSTEMI heparin is used routinely.
Answer C	Metoprolol
Answer C Explanation	Incorrect Metoprolol is not used as the first line in NSTEMI
Answer D	Order CK-MB
Answer D Explanation	Incorrect No use to repeat CK-MB now in this case, CK-MB is elevated for 2-3 days
Answer E	Stress test
Answer E Explanation	Incorrect The patient in NSTEMI and no need for stress test in this case.
Right Answer	B
Explanation	Non ST Segment Elevation Myocardial Infarction (NSTEMI) management is different in that there is no use of thrombolytic, heparin is used routinely, glycoprotein IIb/IIIa lower mortality particularly in those undergoing angioplasty. Educational Objective: References:
Approved	No
Keyword	[[WBRKeyword::NSTEMI]]
Linked Question
Order in Linked Questions