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  #1  
Old 09-25-2012
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Default Cardiology High Yield

A 65 year old man presents to the emergency department with chest pain for the past 1 hour .ECG shows ST depression in Anterior leads.Aspirin is given.
Which of the following is the next best step in the management of the patient ?

A. Atorvastatin
B. Enoxaparin
C. Metoprolol
D. Nitroglycerin
E. Thrombolytics
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Old 09-25-2012
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Quote:
Originally Posted by step_enhancer View Post
A 65 year old man presents to the emergency department with chest pain for the past 1 hour .ECG shows ST depression in Anterior leads.Aspirin is given.
Which of the following is the next best step in the management of the patient ?

A. Atorvastatin
B. Enoxaparin
C. Metoprolol
D. Nitroglycerin
E. Thrombolytics
B.........................
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Old 09-25-2012
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Enoxaparin, there is no reason and no proven benefit with thrombolytic therapyin Non STEMI.

BB can be given after the patient receives the typical MONAH treatment

Morphine
O2
Nitroglycerin
Aspirin
Heparin or similar
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D. Nitroglycerin since he is having chest pain.
Next should be heparin.
Thrombolytics don't have a role in NSTEMI
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Originally Posted by Novobiocin View Post
D. Nitroglycerin since he is having chest pain.
Next should be heparin.
Thrombolytics don't have a role in NSTEMI

So in chest pain we first give nitroglycerin ?
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Old 09-25-2012
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yes ans is D ...... nitro will decrease preload and decrease o2 demand and help in resolving ischemia ........
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Quote:
Originally Posted by XpaezX View Post
So in chest pain we first give nitroglycerin ?
As you said, in real life you give Aspirin, O2, Morphine & Nitroglycerine ( reduces preload--> decreases myocardial O2 demand) simultaneously. But since the question is asking the next best step in a patient who is having chest pain and morphine (as well as O2) is not among the choices, Nitroglycerine is the only one left since Aspirin has already been given.

Remember, if a patient presents with any sort of pain, you gotta relieve the pain first unless there is a contraindication.
e.g. Renal colic.
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Last edited by Novobiocin; 09-25-2012 at 10:44 AM.
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Answer B Enoxaparin

I will put the detailed explanation ,tomorrow.I have to go somewhere
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Tomorrow is a big day for many ,many people getting there results .
Tomorrow forum will be in full activity
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Tomorrow we will se how much vaseline we are gonna need for the D day
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Quote:
Originally Posted by step_enhancer View Post
Answer B Enoxaparin

I will put the detailed explanation ,tomorrow.I have to go somewhere
yes missed this crap , its ST depression so after aspirin next step is Heparin (Enoxaparin here ) no dec in mortality with nitro , o2 and morphine for st depression .
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Tomorrow we will se how much vaseline we are gonna need for the D day
I guess we are going to be wicked guys who will read all posts of child abuse to reduce the amount of lubrication that we will need for the D day ......
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i think its Nitro but can see why ppl think it is enox. however if the patient is going for angio they wont get enxo cause increases there risk of bleeding particular via the femoral route
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Old 09-26-2012
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Answer B Enoxaparin

Aspirin and low molecular weight heparin are the best initiating therapy for a NON-ST segment elevation MI. This type of infarction is based on a clot that is in the process of forming in the coronary artery. Heparin works to prevent clots from forming. Low molecular weight heparin is superior to unfractionated heparin in terms of mortality and is also easier to use because it does not require monitoring of the aPTT.

Statins and metoprolol also lower mortality, but their effect is not as dependent on the time course and rapid administration as low molecular weight heparin .
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Quote:
Originally Posted by step_enhancer View Post
A 65 year old man presents to the emergency department with chest pain for the past 1 hour .ECG shows ST depression in Anterior leads.Aspirin is given.
Which of the following is the next best step in the management of the patient ?

A. Atorvastatin
B. Enoxaparin
C. Metoprolol
D. Nitroglycerin
E. Thrombolytics
B.) ENOXAPARIN for NSTEMI and unstable angina
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