A 48-year-old man with a history of hypercholesterolemia presents to the emergency department with 1 hour of substernal chest pain, nausea, and sweating. His ECG is shown below. There is no history of hypertension, stroke, or any other serious illness.
Which of the following is most appropriate at this time?
The ECG shows acute ST-segment elevation in the anterior precordial leads. The symptoms have persisted for only 1 hour, so the patient is a candidate for primary percutaneous coronary intervention (angioplasty and/or stenting) or thrombolytic therapy, depending on the setting. Aspirin should be given. Nitroglycerin and morphine are indicated for pain control. Beta-blockers reduce pain, limit infarct size, and decrease ventricular arrhythmias. There is no role for calcium-channel blockers in this acute setting (in fact, short-acting dihydropyridines may increase mortality).
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