NSTEMI Flashcards
What is an NSTEMI?
NSTEMI (Non-ST-Elevation Myocardial Infarction) is a type of acute coronary syndrome characterised by myocardial necrosis without ST-segment elevation on ECG.
How does NSTEMI differ from STEMI?
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.
What are the common symptoms of NSTEMI?
Symptoms include chest pain (often described as tight or crushing), radiating pain to the arm, neck, or jaw, dyspnoea, nausea, and diaphoresis.
What is the aetiology of NSTEMI?
NSTEMI is caused by atherosclerotic plaque rupture leading to thrombosis and partial coronary artery occlusion.
What is the pathophysiology of NSTEMI?
Plaque rupture and thrombus formation result in reduced coronary blood flow, causing myocardial ischaemia and necrosis.
What are the risk factors for NSTEMI?
Hypertension, smoking, diabetes, hyperlipidaemia, obesity, sedentary lifestyle, and family history of cardiovascular disease.
How is NSTEMI diagnosed?
Diagnosis is based on clinical presentation, ECG changes (e.g., ST depression or T-wave inversion), and elevated cardiac biomarkers (e.g., troponin).
What are the typical ECG findings in NSTEMI?
ST-segment depression, T-wave inversion, or non-specific changes, but no ST elevation.
What role do cardiac troponins play in diagnosing NSTEMI?
Elevated troponin levels indicate myocardial injury, distinguishing NSTEMI from unstable angina.
What investigations are performed in suspected NSTEMI?
ECG, serial troponins, chest X-ray, echocardiography, and coronary angiography.
What are the differential diagnoses for NSTEMI?
Pulmonary embolism, pericarditis, aortic dissection, pneumothorax, gastro-oesophageal reflux disease, and musculoskeletal chest pain.
What is the initial management of NSTEMI?
ABCDE assessment, oxygen if hypoxic, aspirin, P2Y12 inhibitor (e.g., clopidogrel), and anticoagulation (e.g., heparin).
What is the role of dual antiplatelet therapy (DAPT) in NSTEMI?
DAPT with aspirin and a P2Y12 inhibitor reduces thrombus formation and prevents further ischaemic events.
What is the GRACE score, and how is it used in NSTEMI?
The GRACE score estimates the risk of mortality and recurrent myocardial infarction, guiding decisions on invasive management.
What are the medical management options for NSTEMI?
Antiplatelets, anticoagulants, beta-blockers, ACE inhibitors, statins, and nitrates for symptom control.
What is the role of beta-blockers in NSTEMI management?
Beta-blockers reduce myocardial oxygen demand by lowering heart rate and blood pressure, improving outcomes.
When is coronary angiography indicated in NSTEMI?
It is indicated in high-risk patients to assess coronary anatomy and guide revascularisation strategies like PCI or CABG.
What is the difference between PCI and CABG in NSTEMI management?
PCI involves using stents to open blocked arteries, while CABG involves surgically bypassing the blocked arteries.
What are the complications of NSTEMI?
Heart failure, arrhythmias, recurrent ischaemia, cardiogenic shock, and death.
What lifestyle modifications are recommended post-NSTEMI?
Smoking cessation, a heart-healthy diet, regular exercise, weight management, and adherence to medications.
How can NSTEMI be prevented in high-risk individuals?
Managing risk factors like hypertension, diabetes, and hyperlipidaemia, along with lifestyle changes and prophylactic medications (e.g., statins, antiplatelets).
What is the role of statins in NSTEMI management?
Statins reduce LDL cholesterol levels and stabilise atherosclerotic plaques, decreasing the risk of recurrent events.
How is NSTEMI managed in patients with renal impairment?
Adjustments to anticoagulants and medications like ACE inhibitors may be required to minimise the risk of renal damage.
What is the prognosis for patients with NSTEMI?
Prognosis depends on the severity of the event, comorbidities, and timeliness of treatment; early intervention improves outcomes.
