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Acute Inferior Wall Myocardial Infarction 1

Acute inferior wall myocardial infarction


Vignette: A 45-year-old man with a history of hypertension and smoking presents to the clinic with complaints of worsening chest pain. His vital signs are stable. His ECG shows ST-segment elevation in leads II, III, and aVF. He is diagnosed with an acute inferior wall myocardial infarction and promptly started on treatment. Which of the following medications is most likely to reduce his mortality?


A) Nitroglycerin

B) Morphine

C) Aspirin

D) Metoprolol

E) Atropine


C) Aspirin


In the setting of an acute myocardial infarction (MI), early administration of aspirin is a life-saving intervention. Aspirin irreversibly inhibits cyclooxygenase-1 and -2, reducing the synthesis of thromboxane A2, which is a potent platelet aggregator and vasoconstrictor. Thus, aspirin has an antiplatelet effect, preventing further clot formation in the coronary arteries, which can reduce the extent of the MI and lower the risk of death. Nitroglycerin is used for symptomatic relief as it is a vasodilator but does not directly reduce mortality. Morphine is also used for symptomatic relief. Metoprolol, a beta-blocker, can be used in the setting of an MI to reduce the workload of the heart, but its effect on mortality is not as immediate as that of aspirin. Atropine is used to treat bradycardia or heart block, which can occur in the setting of an MI, but does not reduce mortality.


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