Diagnosis and Patient Presentation

The patient presents with symptoms of acute chest pain, confirmed by ECG findings of an inferior wall Myocardial Infarction (MI). He is 70 years old and has a recent history (7 days prior) of an anterior wall MI treated with streptokinase (thrombolysis).

Initial Medical Management

Standard initial medical therapy for acute MI includes:

• Aspirin: An antiplatelet medication to prevent further clot formation.
• Sublingual nitroglycerin: To relieve chest pain and improve blood flow.
• Clopidogrel: Another antiplatelet agent, often given in conjunction with aspirin (Dual Antiplatelet Therapy - DAPT) in acute MI.

Reperfusion Strategy Selection

The choice of reperfusion therapy is critical in acute MI. Current guidelines favour Primary Percutaneous Coronary Intervention (PCI) for ST-elevation myocardial infarction (STEMI) if it can be performed promptly.

• Primary PCI: This is the preferred method for restoring blood flow in acute MI, especially when available within recommended timeframes.
• Recent Thrombolysis: The patient received streptokinase 7 days ago. While reperfusion is needed, re-administering thrombolytic therapy like streptokinase is generally avoided due to potential for allergic reactions and reduced efficacy after recent use.
• Heparin: Often used adjunctively with PCI or thrombolysis but is not the primary reperfusion strategy itself in this context.
• Beta-blockers: Important medications for long-term management and reducing cardiac workload, typically initiated after stabilization and reperfusion.

Considering the acute inferior wall MI and the availability of Primary PCI, it is the most appropriate reperfusion strategy. The combination of Aspirin, Sublingual nitroglycerin, Clopidogrel, and Primary PCI constitutes the recommended management.