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A 66-Year-Old Retired Police Officer Is Brought to the Emergency

question 46

Multiple Choice

A 66-year-old retired police officer is brought to the emergency department due to abrupt-onset sharp anterior chest pain. The pain started approximately 2 hours ago while he was working on his car in the garage. The patient describes the pain, which radiates to his neck and lower jaw, as "the worst pain of my life." He also has epigastric discomfort. Medical problems include hypertension, hyperlipidemia, and benign prostatic hyperplasia. Medications include hydrochlorothiazide, losartan, tamsulosin, atorvastatin, and daily aspirin. The patient has a 30-pack-year smoking history but quit approximately 5 years ago. He is physically active and jogs 2-3 miles on most days.
Temperature is 37.2 C (99 F) , blood pressure is 201/104 mm Hg in the right upper arm and 198/94 mm Hg in the left upper arm, pulse is 90/min, and respirations are 22/min. Pulse oximetry is 95% on room air. The patient appears very uncomfortable due to pain. There is a faint early diastolic murmur at the left sternal border and an S4 at the apex. The lungs are clear to auscultation. Mild epigastric tenderness is present on deep palpation without rebound. There is no peripheral edema, and lower extremity pulses are symmetric.
ECG shows high-voltage QRS complexes in the precordial leads and nonspecific ST-segment and T-wave changes.
Which of the following is the most appropriate initial treatment for this patient?

Definitions:

Gender Stereotypes

Broad categories that reflect impressions and widely held beliefs about what behavior is appropriate for females and males.

Androgyny

A gender expression that blends or combines characteristics traditionally associated with both masculinity and femininity.

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A study or evaluation of the United Nations Children's Fund's programs and effectiveness in promoting children's rights and well-being around the globe.

Education

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