NSTEMI Flashcards
Define NSTEMI.
Non-ST-elevation myocardial infarction (NSTEMI) is an acute ischaemic event causing myocyte necrosis. The initial ECG may show ischaemic changes such as ST depressions, T-wave inversions, or transient ST elevations; however, it may also be normal or show non-specific changes.
Explain the aetiology/risk factors of NSTEMI.
Atherosclerosis
Diabetes
Smoking
Dyslipidaemia
Age >65 years
Hypertension
Obesity and metabolic syndrome phenotype
Physical inactivity
Cocaine use
Depression
Stent thrombosis or restenosis
Chronic kidney disease
Sleep apnoea
Summarise the epidemiology of NSTEMI.
Epidemiology data have shown that acute coronary syndrome (ACS) cases with ST-elevation myocardial infarction (STEMI) appear to be declining and that NSTEMI occurs more frequently than STEMI.
Recognise the presenting symptoms of NSTEMI. Recognise the signs of NSTEMI on physical examination.
Chest pain
Diaphoresis
Physical exertion
Shortness of breath
Weakness
Anxiety
Nausea
Vomiting
Abdominal pain
Hypertension
Identify appropriate investigations for NSTEMI and interpret the results.
ECG
Troponin
Glucose
U+Es
Creatinine
Cardiac angiogram
CXR
LFTs
CK
Generate a management plan for NSTEMI.
1st line: Antiplatelet therapy (aspirin + clopidogrel, ticagrelor or prasugrel)
Adjunct:
Oxygen
Glyceryl trinitrate ± morphine
Beta-blocker
Calcium-channel blocker
Identify the possible complications of NSTEMI and its management.
Cardiac arrhythmias
Congestive heart failure (CHF)
Cardiogenic shock
Ventricular rupture or aneurysm
Acute mitral regurgitation
Post-MI pericarditis (Dressler syndrome)
Venous thromboembolism (VTE)
Summarise the prognosis for patients with NSTEMI.
Patients who have experienced NSTEMI have a high risk of morbidity and death from a future event. The rate of sudden death in patients who have had a myocardial infarction (MI) is 4 to 6 times the rate in the general population.
