HY USMLE Q#2  CVS Concepts Step 2 CK

​Step 2ck/ 3 level (inspired by UWORLD) 

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Instagram = @notadoctoryet11

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A 50-year-old man presents to the emergency department with chest pain for the past hour. He was clearing the snow when he suddenly felt substernal chest pressure radiate to the left jaw and was not relieved by rest or nitroglycerin. His pulse is 34/min. ECG shows sinus bradycardia with 3 mm ST segment elevation in leads 2,3,avF.  What is the most appropriate initial step in management?​

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A. IV Fluids

B. Nitroglycerin 

C. Norepinephrine 

D. Temporary pacing

E. Atropine

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​Explanation:

✅ E. Atropine → Decreased vagus nerve activity, hence it will help for bradycardia.
❌ A. IV Fluids → Saline, without increasing HR, may worsen pulmonary edema.
❌ B. Nitroglycerin → Causes decreased preload via venous dilation; contraindicated in hypotension or preload-dependent RV MI.
❌ C. Norepinephrine → Binds α1 receptors; used for septic shock.
❌ D. Temporary pacing → Used as second-line therapy if atropine fails. ​​

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