Question

A 49-year-old man presents with chest pain. He has had this type of pain in the past, but it typically occurred with significant exertion, such as shoveling snow. Over the past 2 weeks, however, the pain has come on with progressively less activity, and today the pain persists despite rest. Although he has a history of hypertension, he admits to rarely taking his antihypertensive medication. On examination, his HR is 95 beats per minute, and his blood pressure is 212/100 mm Hg. An electrocardiogram is performed and reveals ST elevation in the anterolateral leads.

What medication would be the most appropriate treatment?

1 Adenosine
2 Furosemide
3 Methyldopa
4 Nifedipine
5 Nitroprusside

Answer 1

The 49-year-old man with chest pain and ST elevation in the anterolateral leads on an ECG is likely experiencing a myocardial infarction. The most appropriate medication to treat his condition from the provided options is nitroglycerine, which is used to treat chest pain and high blood pressure. In a hospital, nitroprusside may also be considered for hypertensive emergencies.

Step-by-step explanation:

The man described in the scenario is experiencing a medical condition characterized by chest pain that is occurring with progressively less activity and persisting despite rest. This symptom, combined with the ST elevation in the anterolateral leads on the electrocardiogram (ECG), suggests that he may be experiencing an acute myocardial infarction (MI), commonly known as a heart attack. Given his history of hypertension and the findings, the most appropriate medication among the options listed would be nitroglycerine. Nitroglycerine is used to treat high blood pressure, chest pain (angina) due to reduced blood supply to the heart muscle, and arrhythmias. In the context of an MI, it acts as a vasodilator and is administered sublingually to alleviate chest pain and improve blood flow to the heart muscle.

The other medications listed are used for different indications and would not be appropriate for the immediate treatment of an MI. Immediate treatments for MI include oxygen, aspirin, and nitroglycerine; however, in a hospital setting and given the severity of the man's high blood pressure, intravenous nitroglycerine or other similar agents for blood pressure control and the relief of chest pain may be used under careful monitoring, making option 5, nitroprusside, also a potential consideration for the treatment of hypertensive emergencies associated with MI. It is essential for the patient to receive emergency medical attention, and he will likely require further interventions such as thrombolytics, anticoagulation, and potentially invasive procedures depending on the severity of his condition.