A 78 year old male is admitted with chest pain. His ECG shows widespread ST depression in all leads except aVR which shows ST elevation. Whilst in ER, he passes melaena and on fuher questioning, gave history of altered bowel habit, weight loss and dark stools for 2-3 months. O/E he is pale, pulse rate is 115 bpm and BP is 80/50 mmHg. Blood tests demonstrate a hemoglobin of 3.6g/l and a high-sensitivity troponin of 140ng/l. What is the best initial management?
Dx is NSTEMI : Type 2 MI (due to Anemia) Option A : No, as he is already having GI bleeding, so antiplatelet therapy is not given. Option B : Yes, packed RBC transfusion is useful for anemia component to | oxyhemoglobin. Option C : Nitrates are C/I if Systolic B.P <80 mm Hg Option D : He's already having hypotension & b blockers are C/I in hypotension
Aggressive treatment with dual antiplatelets
Packed RBC transfusion
Nitrates to relieve ischemia
Beta blocker to slow hea rate and reduce ischaemia
Emergency Clinical Scenario