Cardiac Medicine Certification (CMC) Practice Exam

In the case of NSTEMI, what medication should be initiated within 30 minutes of patient arrival to the ER?

1. Beta-blockers

2. tPA

3. ACE inhibitors

4. Statins

The correct answer is: tPA

For a patient presenting with a Non-ST-Elevation Myocardial Infarction (NSTEMI), the administration of thrombolytics such as tissue plasminogen activator (tPA) is not the first-line treatment. This is primarily because thrombolytics are more appropriately used in cases of ST-Elevation Myocardial Infarction (STEMI) to rapidly dissolve clots in obstructed arteries. In the context of NSTEMI, the appropriate management strategy often includes antiplatelet therapy, beta-blockers, ACE inhibitors, and statins, among others, which aim to stabilize the condition and manage risk factors. In particular, starting statin therapy early has significant benefits in terms of secondary prevention and is generally recommended in NSTEMI cases, reinforcing the importance of lipid management. Therefore, while tPA is crucial in the management of acute STEMI patients to restore blood flow, it is not the correct initial medication for NSTEMI and should not be initiated upon arrival in the emergency room. Statins, on the other hand, are pivotal in improving outcomes for NSTEMI patients and should be initiated early after diagnosis to aid in managing cholesterol levels and reducing the risk of further cardiac events.