Question
Allof the following are used in the management of the condition represented in the picture below except?
A. Aspirin.
B. Heparin.
C. Alteplase.
D. Warfarin.
Show Answer
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Correct Answer » D Explanation |
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Ans: D. Warfarin.
The image is showing a case of Myocardial infarction due to blockage of coronay vessel due to atherosclerosis.
Myocardial infarction.
- It is the irreversible death (necrosis) of heart muscle secondary to prolonged lack of oxygen supply (ischemia). .
- It is very important to distinguish whether the patient is having an ST-elevation MI (STEMI) or a non–STEMI (NSTEMI), because definitive therapies differ between these two types of MI.
Prehospital care includes :
- Intravenous access, supplemental oxygen if the oxygen saturation (SaO 2) is less than 90%,
- Immediate administration of aspirin ,
- Nitroglycerin for active chest pain, given sublingually or by spray.
STEMI:
- Early mechanical intervention (percutaneous coronary intervention ) or pharmacologic reperfusion should be performed as soon as possible for patients with clinical presentation of STEMI
- Fibrinolysis:Streptokinase ,Tenecteplase,Reteplase (rPA),Alteplase (tPA) ).
- Anticoagulant agents are an important adjunctive therapy for reperfusion therapy :Unfractionated heparin (UFH), bivalirudin,and low molecular weight heparin (LMWH) (eg, enoxaparin ) .
Non-STEMI:
Two alternative management strategies,
- Early invasive strategy with angiography, with intent for revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), or
- a conservative strategy with initial medical therapy and noninvasive cardiovascular imaging.
- Regardless of the strategy, both entail aggressive utility of medications such as anticoagulants, antiplatelet agents, beta blockers, statins, and possible use of angiotensin-converting enzyme (ACE) inhibitors.
Warfarin is not indicated in the immediate management of Acute myocardial infarction. Warfarin is the single best answer of exclusion.
