Ischemic Heart Disease: NSTEMI Flashcards
Define NSTEMI
Non-ST-elevation myocardial infarction (NSTEMI) is an acute ischaemic event causing myocyte necrosis that does not involve ST elevation on ECG
How does the pathophysiology of an NSTEMI compare to STEMI?
STEMI often involves complete occlusion of the coronary artery
NSTEMI involves a transient or near complete occlusion or an acute factor that deprives the myocardium of oxygen.
What are the typical characteristics of chest pain presentation due to NSTEMI? (4)
Chest pain is described as pressure, tightening or burning.
Pain may radiate to the neck, jaw, left or right arm and/or both arms.
Chest pain lasts longer than 15 minutes
Triggered by little to no exertion
List some associated symptoms that can present alongside chest pain in patients with NSTEMI (5)
Nausea
Vomitting
SoB
Significant sweating (e.g. claminess)
Upper back pain
Signs of haemodynamic instability: E.g. hypotension, arrhythmias, syncope, peripheral cyanosis, decreased urine output.
How does the presentation of NSTEMI differ between males and females?
Males: More likely to have nausea, vomitting
Females: More likely to have upper back pain
List 9 examples of signs/symptoms of haemodynamic instability
Abnormal heart rate (arrhythmias)
Chest pain
Peripheral cyanosis
Confusion
Decreased urine output
Hypotension
Syncope
Restlessness
Shortness of breath
What ECG changes can be present in NSTEMI? (3)
ST deppresion
Transient ST elevation
T-wave inversion
What investigations should be ordered in patients suspected of MI? (6)
ECG
High sensitivity troponin
FBC (determine bleeding risk)
U&Es (need eGFR to calculate GRACE score)
LFTs (determine beelding risk)
Blood glucose (identify DM risk factor or manage hyperglyacemia in known diabetics)
Why should symptom improvement upon GTN use should not be used as a diagnostic for ischeamic heart disease?
Other causes of chest pain such as oesophageal spasms can be relieved upon GTN use
What is the management plan for NSTEMI?
300mg Aspirin (Check for allergies or significant bleeding risk) and Fondaprinux (antithrombin)
Give pain relief (3 doses of translingual/sublingual glyceryl trinitrate)
Calculate GRACE (mortality predictor)
For low risk mortality: Give aspirin and ticagrelor OR aspririn and clopdogrel (P2Y12 inhibitor) if bleeding risk.
For intermediate/high risk mortality: Angioplasty if unstable, tricagrelor and aspirin.
Replace tricagrelor with prasugrel if undergoing a PCI (angioplasty with stenting)
List complications that can arise due to NSTEMI
Cardiogenic shock
Cardiac arrhytmias
Acute heart failure
Dressler syndrome
What is dressler syndrome?
Pericarditis secondary to MI
How is dressler syndrome managed?
High dose aspirin
