MRCP2-0479

MRCP2-0479

A 35-year-old accountant from New York City presents to the Emergency department with severe chest pain that radiates down both arms. He admits to using cocaine regularly and had snorted two lines shortly before the onset of his symptoms. He also smokes 30 cigarettes per day. On examination, his blood pressure is 160/95 mmHg, and his pulse is 90 and regular. Bilateral crackles are heard on chest auscultation. Laboratory investigations reveal a haemoglobin level of 140 g/L (135-177), a white cell count of 7.2 ×109/L (4-11), and a platelet count of 190 ×109/L (150-400). His sodium level is 139 mmol/L (135-146), potassium level is 4.0 mmol/L (3.5-5), and creatinine level is 105 µmol/L (79-118). An ECG shows widespread anterior ST elevation. The patient is given aspirin, clopidogrel, and low molecular weight heparin.

What is the recommended next step before referring the patient to a cardiologist for consideration of primary angioplasty?