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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
Signs
Levine’s sign, diaphoresis, dyspnoea
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
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)
Prognosis
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 anxietyKey Facts
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Key Images
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Key References
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