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INI-CET 2014 — Internal Medicine

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

Thrombolytic therapy. ***Thrombolytic therapy*** - The ECG shows significant **Q waves** and **T-wave inversion** in inferolateral leads (II, III, aVF, V5, V6), indicating an **evolving or established myocardial infarction** (MI), not an acute ST-elevation MI (STEMI suitable for immediate thrombolysis). - Given the symptoms began 24 hours ago, the patient is likely outside the optimal window for thrombolytic therapy, which is most effective within **12 hours** of symptom onset for STEMI. After 12-24 hours, the benefits are marginal, and risks of bleeding increase. *Aspirin* - **Aspirin** is an integral part of NSTEMI/STEMI management as an **antiplatelet agent**, given to almost all patients who are not allergic, regardless of time of presentation. - It works by **inhibiting cyclooxygenase** and thereby reducing platelet aggregation, preventing further clot formation. *Statin* - **Statins** are initiated early in MI management, even in the acute phase, for their **pleiotropic effects** beyond lipid-lowering, including **stabilizing plaques** and reducing inflammation. - Long-term statin therapy is crucial for **secondary prevention** in patients with established coronary artery disease. *Morphine* - **Morphine** is often used in the acute management of MI for **pain relief** and can also provide some **venodilation**, reducing preload and myocardial oxygen demand. - While typically used during the active chest pain phase, it remains an option for symptom management if pain persists, even after 24 hours. *Beta-blockers* - **Beta-blockers** are a cornerstone of post-MI management, started within the first 24 hours in hemodynamically stable patients without contraindications. - They reduce **myocardial oxygen demand**, prevent arrhythmias, and improve long-term survival. - Standard therapy even at 24 hours post-MI presentation. [Practice more Internal Medicine PYQs on OnCourse]

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All Subjects Biochemistry (1)Forensic Medicine (1)Internal Medicine (1)Internal Medicine (3)Ophthalmology (1)Pathology (1)Pediatrics (2)Pharmacology (2)Surgery (1)

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