**Question:** A 60-year-old female presented to the ER with chest pain and dyspnoea, along with palpitations, nausea, vomiting, and few episodes of syncope. MI was suspected. The relatives of the patient told that a near one of the patient had died yesterday only. ECG of the patient lab findings revealed raised cardiac enzymes. ECHO was also done. Patient was planned for coronary angiography. It was observed that there was no coronary artery stenosis. What is the drug of choice for the above condition: -

A. Aspirin
B. Beta-blocker
C. Enalapril
D. Analgesic

**Core Concept:** Myocardial infarction (MI) is a life-threatening cardiovascular emergency characterized by acute myocardial ischemia due to thrombus formation in the coronary arteries. Treatment principles include early revascularization, antiplatelet therapy, and anti-ischemic medication.

**Why the Correct Answer is Right:** In this case, the patient has been diagnosed with acute myocardial infarction despite the absence of coronary artery stenosis on coronary angiography. This indicates the presence of other causes for the patient's symptoms, such as plaque rupture, spontaneous coronary artery dissection, or microvascular dysfunction.

**Why Each Wrong Option is Incorrect:**

**A. Aspirin (Diclofenac):** While aspirin does have antiplatelet properties, it is not the first choice for MI management. Instead, it is used in combination with clopidogrel for primary prevention of cardiovascular events, as well as in secondary prevention after a known MI or stroke. In this case, aspirin might be considered as an alternative if the patient has contraindications to clopidogrel therapy.

**B. Beta-blocker (Propranolol):** Beta-blockers are used in patients with known MI to reduce heart rate, blood pressure, and myocardial oxygen demand, thus improving oxygen supply to the ischemic myocardium. However, in this case, there is no mention of the patient's history of hypertension or tachycardia, so beta-blocker administration is unnecessary. Additionally, beta-blockers may worsen heart failure symptoms or impair oxygen delivery in some cases.

**C. Enalapril (ACE inhibitor):** ACE inhibitors are used in patients with left ventricular dysfunction, heart failure, or hypertension to reduce afterload and improve cardiac output. In this case, there is no mention of heart failure or hypertension, so ACE inhibitors are not indicated.

**D. Analgesic (NSAIDs):** NSAIDs (nonsteroidal anti-inflammatory drugs) are used for pain relief and inflammation control in acute myocardial infarction. However, no mention of pain or inflammation in the case description. Additionally, NSAIDs may increase bleeding risk, which is a contraindication in this patient.

**Clinical Pearls:**

- In the case of a suspected MI, the primary management focuses on reperfusion therapy (thrombolysis or percutaneous coronary intervention) when indicated, anticoagulation therapy, and antiplatelet therapy (aspirin and clopidogrel).
- Beta-blockers