Acute Coronary Syndromes

Acute Coronary Syndromes

Unstable Angina/Non-ST Elevation MI (NSTEMI)


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


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.

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