Step 2

Cardiovascular 15

A 78-year-old man presents to the emergency department for evaluation of sudden onset squeezing chest pain with radiation to the left shoulder. He has felt this way before on several occasions, but the sensation has never persisted more than 30 seconds. Past medical history is significant for hypertension. Physical examination reveals diaphoresis and tachycardia, and an electrocardiogram is significant for ST elevations in leads I, aVL, V5 and V6. Percutaneous coronary intervention is not available, and the next closest hospital is three hours away.

Which of the following agents is the most appropriate next step in this patient’s care?

  • A) Alteplase
  • B) Bivalirudin
  • C) Enoxaparin
  • D) Fondaparinux
  • E) Unfractionated heparin


Alexandra Conway


Dr. Ted O'Connell

Last updated

Nov 08, 2023

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