3 Hours Of Continuous in Medicine / Internal Medicine — 60yo Man | Cardiology | SMLE Q#17969
SMLE Question #17969
Medicine / Internal Medicine
Cardiology
Objective: OBJ-163
Last updated: February 2026
A 60-year-old man with long-standing type 2 diabetes and hypertension presents with 3 hours of continuous retrosternal heaviness radiating to the left arm, with diaphoresis and nausea. He received aspirin, clopidogrel, metoprolol, and IV nitroglycerin. ECG shows a new left bundle branch block with concordant ST elevation (≥1 mm) in lateral leads. The hospital has no PCI service, and transfer time to a catheterisation lab is >120 minutes. He has no contraindications to fibrinolysis. What is the most appropriate next step in management?
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