Pathology: Part of the acute coronary syndrome spectrum of conditions that result from acute myocardial ischaemia
Aetiology: Atheromatous plaque rupture and partial luminal obstruction by thrombus
Symptoms: Central chest heaviness or tightness, heavy arms, nausea, and breathlessness. Beware ‘atypical’ presentations- symptoms may occur with increasing frequency or severity, at rest or be new onset and severe
Signs: Levine’s sign, diaphoresis, dyspnoea
Investigations: Bloods: FBC, U&E, lipid profile, blood glucose, serial troponin (presence
Indicates NSTEMI while absence indicates unstable angina).
ECG: ST depression or T-wave inversion
Risk stratification: TIMI or Grace Risk Scores
Treatment: Analgesia and oxygen as required
Nitrates
β-receptor antagonists
Aspirin, clopidogrel or prasugrel
Low molecular weight heparin
Coronary angioplasty or surgery
Secondary prevention (including a statin and ACE inhibitor)
Complications: Arrhythmias, LV failure, sudden death, RV failure, pericarditis, systemic embolism of mural thrombus, pulmonary embolism, mitral regurgitation, Dressler’s syndrome, depression and anxiety
Prognosis: Hospital mortality in NSTEMI is 3-5%, and 13% at six months Unstable angina/NSTEMI associated with high incidence of late events.
