12-27-2008, 01:40 AM
A previously healthy 27-year-old woman comes to
the emergency
department 1 hour after a 30-minute episode of
shortness of breath,
nausea, diaphoresis, and crushing substernal chest
pain radiating to the
left shoulder; the episode resolved spontaneously.
She is currently
asymptomatic. Her blood pressure is 110/84 mm Hg,
pulse is 70/min, and
respirations are 16/min. Examination shows no
abnormalities. An ECG shows
a normal sinus rhythm and no other abnormalities. Ten
minutes later,
she sits up in bed stating that her symptoms have
returned. Her blood
pressure now is 150/105 mm Hg, pulse is 120/min, and
respirations are
24/min. A repeat ECG shows 5-mm ST-segment elevation
in leads II, III,
and aVF. Her symptoms resolve after administration of
aspirin and
nitroglycerin. An angiography is ordered and shows no
evidence of coronary
atherosclerosis. Which of the following is the most
appropriate
pharmacotherapy?
A
) Angiotensin-converting enzyme (ACE) inhibitor
B
) Aspirin
C
) Benzodiazepine
D
) Calcium-channel blocking agent
E
) Corticosteroids
F
) Thiazide diuretic