NSTEMI

Question 1

What does NSTEMI stand for?

Answer 1

Non-ST segment elevation myocardial infarction.

Question 2

Define a NSTEMI.

Answer 2

A less serious form of heart attack - supply of blood to heart only partially, rather than completely, blocked = smaller section of heart damaged.

Question 3

What is an NSTEMI caused by?

Answer 3

Caused by partial or near-complete occlusion of a coronary artery.

Question 4

What are the differences in presentation between men and women?

Answer 4

· Males - Chest pressure lasting at least several minutes.

· Females - Middle/Upper back pain or dyspnoea.

Question 5

What is the pathophysiology of a NSTEMI?

Answer 5

· Plaque rupture with superimposed non-occlusive thrombus or embolic events leading to coronary vascular obstruction.
· Dynamic obstruction (vasospasm).
· Progressive luminal narrowing.
· Inflammatory mechanisms (vasculitis).
· Extrinsic factors leading to poor coronary perfusion (hypotension, hypovolaemia or hypoxia).

Question 6

What is the risk of a good prognosis dependent on?

Answer 6

Risk factors, presence of heart failure, extent of infarction, treatment given and compliance.

Question 7

What is the difference between a STEMI and a NSTEMI?

Answer 7

STEMI is complete occlusion, whereas NSTEMI is a transient or near-complete occlusion of a coronary artery.

Question 8

List the most common risk factors.

Answer 8

· Atherosclerosis. History of:

• Angina.
• MI.
• Stroke.
• TIA.
• PVD.

· Diabetes.
· Smoking.
· Dyslipidaemia.
· FH of premature CAD.
· Age >65 years.
· HTN.
· Obesity and metabolic syndrome.
· Physical inactivity. 
· CKD.

Question 9

What are the typical signs and symptoms of a NSTEMI?

Answer 9

· Chest pain.
· Diaphoresis.
· Physical exertion. 
· SOB. 
· Anxiety.
· Nausea and vomiting.

Question 10

Define diaphoresis.

Answer 10

Sweating to an unusual degree.

Question 11

Why might diabetics not feel chest pain?

Answer 11

Due to nerve damage

Question 12

What investigations would you request for a suspected NSTEMI patient?

Answer 12

· ECG. 
· Cardiac troponins.
· Creatine kinase. 
· CK-MB.
· FBC. 
· U&E's.
· LFT's. 
· Blood glucose. 
· CXR may show pulmonary oedema

Question 13

What would a typical ECG show?

Answer 13

Non-specific ST and T wave changes.

Question 14

Suggest some differential diagnoses.

Answer 14

· Aortic dissection. 
· PE.
· Peptic ulcer disease.
· Acute pericarditis.
· Oesophageal spasm.
· Costochondritis.
· Myocarditis.
· Stable ischaemic heart disease.

Question 15

What is the treatment option for an acute presentation?

Answer 15

· 1st - Anti-platelet therapy.
· Adjunct - Oxygen.
· Plus - GTN +/- morphine.
· Plus - Beta-blocker.
· Adjunct - CCB.
· PCI/Anti-coagulation or just anti-coagulation.

Question 16

What does MONA TASS stand for when discussing treatment options?

Answer 16

· MONA – morphine, oxygen (only if <94% sats), nitrates (GTN), aspirin

· TASS - thrombolytics, anticoagulants, stool softeners, sedatives.

Question 17

List complications which may occur.

Answer 17

· Cardiac arrhythmia's. 
· Depression. 
· VTE.
· Post-MI pericarditis (Dressler's syndrome).
· Congestive heart failure.