A 65-year-old patient presents to your clinic with a history of chest pain for last 24 hours associated with sweating and diaphoresis. The follow ing ECG findings are seen. BP is 150/90 mm Hg. Which of the following is not given in management of this patient?

**Core Concept**
The patient presents with symptoms suggestive of an acute coronary syndrome (ACS), including chest pain, sweating, diaphoresis, and elevated blood pressure. The management of ACS involves a combination of pharmacological and non-pharmacological interventions to reduce morbidity and mortality.

**Why the Correct Answer is Right**
The management of ACS typically includes the administration of aspirin, beta-blockers, and statins to reduce platelet aggregation, heart rate, and cholesterol levels, respectively. Nitrates are also commonly used to relieve chest pain by reducing myocardial oxygen demand. However, the use of **Option D (digoxin)** is not indicated in the management of ACS, as it is primarily used to treat heart failure and atrial fibrillation.

**Why Each Wrong Option is Incorrect**
* **Option A:** Aspirin is an essential component of ACS management, given its antiplatelet effects.
* **Option B:** Beta-blockers are used to reduce heart rate and myocardial oxygen demand in patients with ACS.
* **Option C:** Nitrates are commonly used to relieve chest pain and reduce myocardial oxygen demand in patients with ACS.

**Clinical Pearl / High-Yield Fact**
In patients with ACS, it's essential to remember that the use of beta-blockers should be initiated cautiously, especially in those with signs of heart failure or low blood pressure, to avoid worsening cardiac function.

**Correct Answer:** D. Digoxin.

✓ Correct Answer: A. Thrombolysis