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Which of the following is the most appropriate medication to treat this dysrhythmia? a. Digoxin b. c. d. e. Diltiazem Amiodarone Adenosine Bretylium 45. A 55-year-old man with hypertension and a 1-pack per day smoking history presents to the ED complaining of three episodes of severe heavy chest pain this morning that radiated to his left shoulder. In the past, he experienced chest discomfort after walking 20 minutes that resolved with rest. The episodes of chest pain this morning occurred while he was reading the newspaper.

The answer is e. ) Thrombolytic therapy (clot-busters) can be administered to patients having an acute ST-elevation MI that is within 6–12 hours from symptom onset. Contraindications to fibrinolytic therapy are those that increase the risk of hemorrhage. The most catastrophic complication is intracranial hemorrhage. Absolute contraindications include: • • • • Previous hemorrhagic stroke Known intracranial neoplasm Active internal bleeding (excluding menses) Suspected aortic dissection or pericarditis Chest Pain and Cardiac Dysrhythmias Answers 33 (a) SBP > 180 mm Hg is a relative contraindication.

This ECG depicts an acute anterior wall myocardial infarction (AMI) with ST elevations in leads V1–V4. The patient is also hypotensive secondary to cardiogenic shock. , angioplasty, coronary stent). It has shown to improve long-term mortality over thrombolytic therapy. (a) b-Blockers and CCBs are contraindicated in patients who are hypotensive. (b) The patient does not have a dysrhythmia and therefore should not be cardioverted. (c) Dobutamine and dopamine are agents used in cardiogenic shock.

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