Non-ST Elevation MI

Non-ST Elevation MI


Part of the acute coronary syndrome spectrum of conditions that result from acute myocardial ischaemia


Atheromatous plaque rupture and partial luminal obstruction by thrombus


Levine’s sign, diaphoresis, dyspnoea


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


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


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)


Hospital mortality in NSTEMI is 3-5%, and 13% at six months Unstable angina/NSTEMI associated with high incidence of late events.

Arrhythmias, LV failure, sudden death, RV failure, pericarditis, systemic embolism of mural thrombus, pulmonary embolism, mitral regurgitation, Dressler’s syndrome, depression and anxiety

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