Non-ST Elevation MI

Question 1

Aetiology of NSTEMI

Answer 1

-Age (increasing- 70+)
-Lifestyle factors: smoking, diet, exercise
-Family history (genetic- younger than 50 heart attack)
-Other risk factors: HTN, DM, High cholesterol, CKD

Question 2

Pathophysiology of NSTEMI

Answer 2

-Atherosclerosis
=Plaque erosion with overlying thrombosis
=Inflammation in plaque disruption
=Platelet aggregation and activation on exposed thrombogenic surface of rupture plaque
=Release mitogenic substances that disrupts endothelium
=Narrowing of lumen

Question 3

NSTEMI symptoms

Answer 3

-Pain= chest (80%), upper abdomen, back, jaw
-Nausea, vomiting
-Sweating
-Dyspnoea (heart failure)
-Palpitations

Question 4

Clinical signs of NSTEMI

Answer 4

-Levine’s sign (fist over chest- in pain, heavy central tightness)
-Rhythm disturbance- Tachycardia, bradycardia (inferior infarct AV node)
-Pulmonary oedema (usually STEMI)
-BP- hypertensive, hypotensive
-Diaphoresis (sweating)

Question 5

NSTEMI Investigations

Answer 5

-Basic observations (BP)
-ECG
-Bloods: troponin
-CXR
-ECHO
GRACE score

Question 6

Diagnostic criteria of NSTEMI

Answer 6

Cardiac biomarkers> 99th percentile ±
1- Symptoms relating to Ischaemia
2- ECG: new/ presumed new ECG changes
3- Q waves on ECG
4- Imaging: new RWMA abnormality

Question 7

NSTEMI treatment

Answer 7

-Analgesia
-Anti-platelets: Aspirin 300mg, Ticagrelor, Clopidogrel, Prasugrel
-Anticoagulation (Heparin)
-ACEi/ beta blockers/ statin
-Anti-anginal: calcium channel blockers, ISMN
-Oxygen (if sats<90%)
-PPI
-Percutaneous coronary intervention within 72 hours of presentation

Question 8

Prognosis of NSTEMI

Answer 8

DARTH VADER

-Death
-Arrhythmia
-Rupture
-Tamponade
-Heart Failure

-Valve disease
-Aneurysm of ventricle
-Dressler’s syndrome
-Embolism
-Recurrence

Question 9

Long-term care NSTEMI

Answer 9

-DAPT
-Secondary prevention: cholesterol, BP, BM
-Lifestyle advice: diet, weight, smoking
-Cardiac rehabilitation