NSTEMI

Question 1

Risk Factors

Answer 1

Non-Modifiable:
- Age
- Sex (Males)
- Family History
- Ethnicity
Modifiable:
- Smoking
- Poor nutrition
- Sedentary lifestyle
- Alcohol
- Stress
- HTN
- Obesity
- DM

Question 2

Pathophysiology

Answer 2

Complete occlusion of minor artery or partial exclusion of major artery resulting in subendothelial infarction (area far away from c.a occlusion dies)

Question 3

Signs and Symptoms

Answer 3

Central crushing pain radiating to jaw and shoulders
Diaphoresis
Dyspnoea
Lasts > 20 mins
Pain not relieved by GTN spray

Question 4

SILENT MI PATIENT

Answer 4

Older patient with poorly controlled diabetes - due to diabetic neuropathy

Question 5

Diagnosis

Answer 5

ECG - Non-ST elevation + T wave inversion
Cardiac enzymes - Myoglobin (1-4 hours), Troponin T+I = cardiac muscle injury (3-12 hours), Creatinine Kinase MB (3-12 hours) - determines re-infarction
Troponin has a shorter half-life than CK-MB therefore CK MB better biomarker after few days
CXR
CT angiography
Bloods

Question 6

Treatment

Answer 6

BATMAN
Betablockers
Aspirin 300mg
Ticagrelor 180mg stat dose (Clopidogrel 300mg if higher bleeding risk)
Morphine titrated to control pain
Anticoagulant: Fondaparux unless high bleeding risk
Nitrates (GTN)
Give O2 if sats below 90%
GRACE SCORE - 6 months risk of dead or repeat MI
< 5% low risk
5-10% medium risk
>10% high risk