NSTEMI

Question 1

What is an NSTEMI?

Answer 1

NSTEMI (Non-ST-Elevation Myocardial Infarction) is a type of acute coronary syndrome characterised by myocardial necrosis without ST-segment elevation on ECG.

Question 2

How does NSTEMI differ from STEMI?

Answer 2

NSTEMI does not show ST-segment elevation on ECG and often results from partial coronary artery occlusion, while STEMI shows ST elevation and usually involves complete occlusion.

Question 3

What are the common symptoms of NSTEMI?

Answer 3

Symptoms include chest pain (often described as tight or crushing), radiating pain to the arm, neck, or jaw, dyspnoea, nausea, and diaphoresis.

Question 4

What is the aetiology of NSTEMI?

Answer 4

NSTEMI is caused by atherosclerotic plaque rupture leading to thrombosis and partial coronary artery occlusion.

Question 5

What is the pathophysiology of NSTEMI?

Answer 5

Plaque rupture and thrombus formation result in reduced coronary blood flow, causing myocardial ischaemia and necrosis.

Question 6

What are the risk factors for NSTEMI?

Answer 6

Hypertension, smoking, diabetes, hyperlipidaemia, obesity, sedentary lifestyle, and family history of cardiovascular disease.

Question 7

How is NSTEMI diagnosed?

Answer 7

Diagnosis is based on clinical presentation, ECG changes (e.g., ST depression or T-wave inversion), and elevated cardiac biomarkers (e.g., troponin).

Question 8

What are the typical ECG findings in NSTEMI?

Answer 8

ST-segment depression, T-wave inversion, or non-specific changes, but no ST elevation.

Question 9

What role do cardiac troponins play in diagnosing NSTEMI?

Answer 9

Elevated troponin levels indicate myocardial injury, distinguishing NSTEMI from unstable angina.

Question 10

What investigations are performed in suspected NSTEMI?

Answer 10

ECG, serial troponins, chest X-ray, echocardiography, and coronary angiography.

Question 11

What are the differential diagnoses for NSTEMI?

Answer 11

Pulmonary embolism, pericarditis, aortic dissection, pneumothorax, gastro-oesophageal reflux disease, and musculoskeletal chest pain.

Question 12

What is the initial management of NSTEMI?

Answer 12

ABCDE assessment, oxygen if hypoxic, aspirin, P2Y12 inhibitor (e.g., clopidogrel), and anticoagulation (e.g., heparin).

Question 13

What is the role of dual antiplatelet therapy (DAPT) in NSTEMI?

Answer 13

DAPT with aspirin and a P2Y12 inhibitor reduces thrombus formation and prevents further ischaemic events.

Question 14

What is the GRACE score, and how is it used in NSTEMI?

Answer 14

The GRACE score estimates the risk of mortality and recurrent myocardial infarction, guiding decisions on invasive management.

Question 15

What are the medical management options for NSTEMI?

Answer 15

Antiplatelets, anticoagulants, beta-blockers, ACE inhibitors, statins, and nitrates for symptom control.

Question 16

What is the role of beta-blockers in NSTEMI management?

Answer 16

Beta-blockers reduce myocardial oxygen demand by lowering heart rate and blood pressure, improving outcomes.

Question 17

When is coronary angiography indicated in NSTEMI?

Answer 17

It is indicated in high-risk patients to assess coronary anatomy and guide revascularisation strategies like PCI or CABG.

Question 18

What is the difference between PCI and CABG in NSTEMI management?

Answer 18

PCI involves using stents to open blocked arteries, while CABG involves surgically bypassing the blocked arteries.

Question 19

What are the complications of NSTEMI?

Answer 19

Heart failure, arrhythmias, recurrent ischaemia, cardiogenic shock, and death.

Question 20

What lifestyle modifications are recommended post-NSTEMI?

Answer 20

Smoking cessation, a heart-healthy diet, regular exercise, weight management, and adherence to medications.

Question 21

How can NSTEMI be prevented in high-risk individuals?

Answer 21

Managing risk factors like hypertension, diabetes, and hyperlipidaemia, along with lifestyle changes and prophylactic medications (e.g., statins, antiplatelets).

Question 22

What is the role of statins in NSTEMI management?

Answer 22

Statins reduce LDL cholesterol levels and stabilise atherosclerotic plaques, decreasing the risk of recurrent events.

Question 23

How is NSTEMI managed in patients with renal impairment?

Answer 23

Adjustments to anticoagulants and medications like ACE inhibitors may be required to minimise the risk of renal damage.

Question 24

What is the prognosis for patients with NSTEMI?

Answer 24

Prognosis depends on the severity of the event, comorbidities, and timeliness of treatment; early intervention improves outcomes.

Question 25

Why is follow-up important after an NSTEMI?

Answer 25

Follow-up ensures optimisation of secondary prevention, monitors for complications, and provides patient education on lifestyle changes.