A 70-year-old woman with NSTEMI is admitted to the medical ward. Her heart rate is 110 bpm, blood pressure is 130/80 mmHg, and she has no signs of heart failure. According to current guidelines, which medication has been shown to reduce mortality in NSTEMI?
- A Diltiazem 90 mg twice daily
- B Nitroglycerin infusion
- C Metoprolol 50 mg twice daily ✓
- D Morphine sulfate IV
Correct answer: C. Metoprolol 50 mg twice daily
Explanation
Beta-blockers are the only class I anti-ischemic medications shown to reduce mortality in ACS. Early IV beta-blockers followed by oral beta-blockers are recommended unless contraindicated (cardiogenic shock, heart block, severe heart failure). Nitroglycerin and morphine are for symptom relief but do not reduce mortality. Diltiazem is used for symptom control when beta-blockers are contraindicated but has no proven mortality benefit.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.