Question
A 60-year-old man comes to the emergency with a history of acute onset chest pain. The ECG shows ST depression and T wave inversion. Cardiac biomarkers in blood are not elevated. What will be the appropriate management?
| A. |
Oxygen + Aspirin + Ticagrelor + Metoprolol
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| B. |
Oxygen + Sublingual Nitroglycerin + Antiplatelets + Streptokinase
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| C. |
Antiplatelets + LMW Heparin subcutaneous
|
| D. |
Oxygen + Sublingual Nitroglycerin + Digoxin
|
Show Answer
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Correct Answer » C
Explanation
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|
The patient has Unstable Angina, characterized by:
- Acute chest pain.
- ST-segment depression and T-wave inversion on ECG.
- Normal cardiac biomarkers (troponin).
Initial management of unstable angina includes:
- Dual antiplatelet therapy (Aspirin + a P2Y12 inhibitor).
- Anticoagulation with LMWH or unfractionated heparin.
- Anti-ischemic therapy (nitrates if required).
- High-intensity statin.
- Early risk stratification for coronary angiography.
Since the question asks for the most appropriate management, dual antiplatelet therapy with LMWH is the best answer.
Why Other Options Are Incorrect
A. Oxygen + Aspirin + Ticagrelor + Metoprolol
- Incorrect because anticoagulation is missing, which is a key component of unstable angina management.
- Oxygen is indicated only if oxygen saturation is <90% or the patient is hypoxemic.
B. Oxygen + Sublingual Nitroglycerin + Antiplatelets + Streptokinase
- Incorrect because fibrinolytic therapy (streptokinase) is contraindicated in unstable angina and NSTEMI.
- It is indicated only for ST-elevation myocardial infarction (STEMI) when timely primary PCI is not available.
D. Oxygen + Sublingual Nitroglycerin + Digoxin
- Incorrect because digoxin has no role in the routine management of unstable angina unless there is another indication such as atrial fibrillation with rapid ventricular response or heart failure.
