A 65-year-old male presents to the ED with substernal chest pain radiating to his left arm, unrelieved by nitroglycerin. ECG shows ST-segment depressions in leads V4-V6. Initial management should include immediate administration of which of the following, assuming no contraindications?

The correct answer to the question "A 65-year-old male presents to the ED with substernal chest pain radiating to his left arm, unrelieved by nitroglycerin. ECG shows ST-segment depressions in leads V4-V6. Initial management should include immediate administration of which of the following, assuming no contraindications?" is Option C: Aspirin, P2Y12 inhibitor (e.g., clopidogrel), heparin, and beta-blocker.

The other options — A) Aspirin, clopidogrel, heparin, and labetalol, B) Aspirin, nitroglycerin, morphine, and oxygen, D) Thrombolytic therapy, aspirin, and clopidogrel — are incorrect for this USMLE Exam Prep question. As explained above: Initial management of NSTEMI/unstable angina includes antiplatelet therapy (aspirin and a P2Y12 inhibitor), anticoagulation (heparin), and beta-blockers, along with symptom relief. Thrombolytics are …