INI-CET 2014 — General Medicine

Q: A 65-year-old elderly male has history of sweating and chest pain for last 24 hr with the following ECG. Which of the following is not given in managing the patient?

Thrombolytic therapy. ***Thrombolytic therapy*** - **Thrombolytic therapy** is contraindicated in this patient due to the **24-hour delay** from symptom onset, as fibrinolytic therapy is generally not recommended beyond **12 hours** and absolutely contraindicated after **24 hours**. - The **risk-benefit ratio** becomes unfavorable after this time window, with increased bleeding risk and minimal myocardial salvage potential, making **primary PCI** the preferred reperfusion strategy if available. *Aspirin* - **Aspirin** remains indicated in STEMI regardless of presentation timing as an **antiplatelet agent**. - It provides ongoing **secondary prevention** benefits and helps prevent further thrombotic events even in delayed presentations. *Statin* - **High-dose statin therapy** is recommended immediately in all ACS patients, including those with delayed presentation. - Statins provide **plaque stabilization** and **anti-inflammatory effects** that are beneficial regardless of symptom onset timing. *Morphine* - While **morphine** is generally avoided in STEMI due to potential **delayed absorption** of oral antiplatelet agents and possible increased mortality, it may still be considered for **severe refractory chest pain**. - It can be used cautiously when **nitroglycerin** fails to provide adequate pain relief, especially in delayed presentations where reperfusion options are limited. [Practice more General Medicine PYQs on OnCourse]

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A 65-year-old elderly male has history of sweating and chest pain for last 24 hr with the following ECG. Which of the following is not given in managing the patient?