B.6 NSTEMI. Etiology, Manifestation, DX

Question 1

B.6 NSTEMI. Etiology, Manifestation, DX

What is ACS

Answer 1

Acute Coronary Syndrome: This refers to the suspicion or confirmed presence of acute myocardial ischemia and/or myocardial infarction. It is further categorized into unstable angina, NSTEMI, and STEMI.

Question 2

B.6 NSTEMI. Etiology, Manifestation, DX

Etiology

Answer 2

Most Common Cause: Coronary artery atherosclerosis

Less Common Causes:
- Coronary artery dissection
- Coronary artery vasospasm (e.g., Prinzmetal angina, cocaine use)
- Takotsubo cardiomyopathy
- Myocarditis
- Thrombophilia (e.g., polycythemia vera)
- Coronary artery embolism
- Vasculitis (e.g., polyarteritis nodosa, Kawasaki disease)
- Myocardial oxygen supply-demand mismatch (e.g., anemia)
- Hypotension
- Hypertrophic cardiomyopathy
- Severe aortic stenosis

Question 3

B.6 NSTEMI. Etiology, Manifestation, DX

Clinical

Answer 3

Classic Symptoms:
- Acute Retrosternal Chest Pain:
- Often described as dull, squeezing pressure or tightness, typically occurring in the morning.
- Radiates to the arms, shoulder, neck, jaw, or epigastric region.

• Dyspnea (particularly with exertion)
• Nausea and vomiting
• Diaphoresis (sweating)
• Anxiety
• Dizziness, lightheadedness, weakness

Other Findings:
- Tachycardia and arrhythmias
- Signs of congestive heart failure (CHF) (e.g., orthopnea, pulmonary edema, or cardiogenic shock).
- Changes on auscultation (e.g., new S4 heart sound).

Atypical Presentation:
- Minimal to no chest pain in elderly, diabetic individuals, and women.
- Possible symptoms: hypotension, jugular venous distention (JVD), and clear lung fields.

Note: STEMI typically manifests with more severe symptoms, while unstable angina/NSTEMI often presents with milder symptoms.

Question 4

B.6 NSTEMI. Etiology, Manifestation, DX

ECG

Answer 4

ECG Changes in NSTEMI/Unstable Angina:

• Absence of ST segment elevations
• Possible nonspecific changes, which may include:
• ST segment depression
• Inverted T waves
• Loss of R wave

Question 5

B.6 NSTEMI. Etiology, Manifestation, DX

Labs

Answer 5

• Elevated Troponin, CK-MB, and LDH (elevated only in NSTEMI)
• Increased WBC and CRP
• Elevated BNP, particularly in cases of heart failure

Question 6

B.6 NSTEMI. Etiology, Manifestation, DX

Coronary Angiography

Answer 6

• The most effective test for the definitive diagnosis of acute coronary occlusion
• Allows for diagnosis and immediate intervention
• Capable of identifying the location and severity of vessel blockage
• Recommended for high-risk acute coronary syndromes (refer to the next topic)