A 60-year-old man comes to the hospital with chest pain. He has had intermittent, squeezing substernal pain over the last 3 days that is now sustained. The patient has no associated palpitations, lightheadedness, or shortness of breath. Medical history is notable for moderate chronic obstructive pulmonary disease with a recent admission for an exacerbation. Blood pressure is 145/90 mm Hg and pulse is 93/min. Oxygen saturation by pulse oximetry is 98% on room air. Physical examination shows no heart murmurs, and lungs are clear to auscultation. ECG shows sinus rhythm with 2-mm anterior ST segment elevation. Cardiac troponin I levels are elevated Which of the following is the most appropriate treatment for this patient?

Question

A 60-year-old man comes to the hospital with chest pain.  He has had intermittent, squeezing substernal pain over the last 3 days that is now sustained.  The patient has no associated palpitations, lightheadedness, or shortness of breath.  Medical history is notable for moderate chronic obstructive pulmonary disease with a recent admission for an exacerbation.  Blood pressure is 145/90 mm Hg and pulse is 93/min.  Oxygen saturation by pulse oximetry is 98% on room air.  Physical examination shows no heart murmurs, and lungs are clear to auscultation.  ECG shows sinus rhythm with 2-mm anterior ST segment elevation.  Cardiac troponin I levels are elevated Which of the following is the most appropriate treatment for this patient?

Quizplus · Accepted Answer

Eductional Objective: In acute myocardial infarction, beta blockers are used to reduce morbidity and mortality by decreasing cardiac output and myocardial oxygen demand. In patients with underlying asthma or chronic obstructive pulmonary disease, non-cardioselective beta blockers (e.g., propranolol, nadolol) can cause bronchospasm. Cardioselective beta blockers (for example, metoprolol) are preferred in such patients because they primarily affect beta-1 receptors.

A 60-Year-Old Man Comes to the Hospital with Chest Pain