A patient is seen in the emergency room for an acute myocardial infarction. The patient's chest pain began around 11 AM after doing morning chores. By 1 PM, the pain did not improve, so the patient came to the emergency room. The nurse anticipates that the physician will order

Nitroglycerin, aspirin, and tissue plasminogen activator (rtPA)


• Fibrin-specific agents such as rtPA can be used to restore perfusion to blocked coronary arteries.  Fibrinolytic therapy is one option for treating acute myocardial infarction when the preferred goal for percutaneous intervention (stent placement) is not an option.  Administration of a "clot buster" to patients who meet criteria including electrocardiogram (ECG) findings is indicated when symptom onset occurs within 12 hours.

• Nitroglycerin is a potent vasodilator and is commonly used for myocardial infarctions to increase blood flow and oxygen to the myocardium.

• Aspirin is used to inhibit platelets and further thrombus formation for any patients with myocardial infarction unless contraindicated.

• Incorrect: A stress test is inappropriate for a patient with diagnosed infarction because it increases oxygen demand and worsens tissue death.  It is indicated for patients with suspected ischemia who are stable and have no clear diagnosis of acute coronary syndrome.  It is used to "rule out" coronary ischemia induced by exercise.

• Incorrect: Atropine is indicated for symptomatic bradycardia and is contraindicated in the setting of myocardial infarction due to increasing oxygen demand.

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