A 65 years old male present in the emergency with severe chest pain for last 2 hours. An acute myocardial infarction is diagnosed. What would be the treatment of choice?

1. A

   Aspirin

2. B

   Streptokinase

3. C

   Atorvastatin

4. D

   Nitroglycerin (NTG)

Appeared in: RML Lucknow - 2021

Explanation

• Streptokinase is a fibrinolytic agent, which is the treatment of choice for an acute ST-segment elevation myocardial infarction (STEMI) when timely percutaneous coronary intervention (PCI) is unavailable.
• The primary goal in early STEMI (within 12 hours, especially the first 2-3 hours) is reperfusion—restoring blood flow to the heart muscle.
• Streptokinase works by converting plasminogen to plasmin, which then breaks down the fibrin clot occluding the coronary artery.
• While other medications like Aspirin and Nitroglycerin are given, Streptokinase is the definitive treatment among the options that directly addresses and resolves the underlying clot.

Why Other Options Were Wrong

• Option A: Aspirin is an antiplatelet drug. It is essential for preventing further clot formation but does not dissolve the existing, occlusive thrombus. It is a crucial adjunctive therapy, not the primary reperfusion treatment.
• Option C: Atorvastatin is a statin used for long-term secondary prevention. It stabilizes atherosclerotic plaques and lowers cholesterol but plays no role in the acute dissolution of a thrombus.
• Option D: Nitroglycerin is a vasodilator used for symptomatic relief of ischemic chest pain. It reduces myocardial oxygen demand but does not dissolve the clot or restore perfusion in a fully occluded artery.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Pharmacological Management of Acute Myocardial Infarction (STEMI) in acute care settings.
• The concept of 'door-to-needle' time is critical in nursing. For fibrinolysis, the goal is to administer the drug within 30 minutes of the patient's arrival at the hospital to maximize myocardial salvage.
• Nurses play a vital role in monitoring for signs of successful reperfusion after fibrinolysis, such as resolution of chest pain, normalization of the ST-segment on the ECG, and the appearance of reperfusion arrhythmias.
• A key nursing responsibility is to screen for contraindications to fibrinolytic therapy (e.g., recent surgery, history of hemorrhagic stroke, active bleeding) and to continuously monitor for complications, especially bleeding.

How to Approach the Question

• First, identify the patient's diagnosis and the urgency. The patient has an 'acute myocardial infarction' with a symptom duration of '2 hours', indicating a time-critical emergency.
• Next, understand the question's core ask: 'What is the treatment of choice?'. This asks for the most definitive and primary intervention, not just any part of the treatment protocol.
• Recall the main goal of acute MI treatment: reperfusion (restoring blood flow).
• Evaluate each option based on its primary mechanism of action in this context.
• Aspirin is antiplatelet (prevents more clotting). NTG is for pain (vasodilator). Atorvastatin is for long-term prevention (lipid-lowering).
• Recognize that Streptokinase is a fibrinolytic, a 'clot-buster', which directly achieves the primary goal of reperfusion. Therefore, it is the treatment of choice among the given options.

Concept Tested & Keywords

• Concept Tested: Pharmacological Management of Acute Myocardial Infarction (STEMI)
• Stem keywords: acute myocardial infarction, severe chest pain, 2 hours, treatment of choice
• Lead-in keywords: treatment of choice
• Clinical cues: Symptom duration of 2 hours places the patient in the optimal window for reperfusion therapy, where benefit is greatest.

Question ID

QltuqW3nxB7GJ1qGmlfYir

Copy ID

Reference Book

E6 Medicine Harrison 22e Part 2 p. 22-24

E6 Medicine Davidson Principles Practice 24e p. 520-522