Rosh Emergency Medicine Practice Test

What medication should be prescribed at discharge to lower the risk of future myocardial infarction in a patient with chest pain?

1. Aspirin

2. Diltiazem

3. Nifedipine

4. Nitroglycerin sublingual

The correct answer is: Aspirin

Aspirin is recommended for patients at discharge after experiencing chest pain, especially if there is a suspicion or confirmation of acute coronary syndrome. The anti-platelet properties of aspirin reduce the likelihood of thrombus formation, which can lead to subsequent myocardial infarctions. By inhibiting cyclooxygenase and decreasing the synthesis of thromboxane A2, aspirin effectively diminishes platelet aggregation. In the context of managing cardiovascular events, antiplatelet therapy is a key component of secondary prevention strategies. For patients with a history of myocardial infarction or those at high risk, long-term aspirin therapy can significantly reduce the incidence of future cardiac events. Other options, such as diltiazem and nifedipine, while used in certain cardiac conditions, generally serve different purposes. Diltiazem is a calcium channel blocker that may help control heart rate or blood pressure, and nifedipine is typically indicated for hypertension and angina relief rather than for preventing future myocardial infarctions. Nitroglycerin sublingual is primarily used for immediate relief of angina symptoms, not for long-term prevention. Thus, aspirin stands out as the most appropriate choice for reducing the risk of future myocardial infarction at the time of discharge.