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Perioperative NSTEMI Management — FRCA Final MCQ

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ModeratePerioperative MedicinePerioperative NSTEMI ManagementFRCA Final

A 50-year-old man (ASA III) with a background of ischaemic heart disease develops chest pain during recovery from a hip replacement. ECG shows 2 mm ST depression in V4-V6. Troponin is elevated. He is haemodynamically stable. What is the initial management in the recovery room?

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Correct answer: B — Aspirin 300 mg, morphine, oxygen if hypoxic, GTN if hypertensive, contact cardiology

Perioperative acute coronary syndrome (NSTEMI with ST depression and elevated troponin) in a stable patient should be managed initially with: aspirin 300 mg (if not contraindicated by recent surgery/bleeding), morphine for pain, oxygen if SpO2 <94%, GTN (if hypertensive/ongoing pain and no recent PDE5 inhibitor use), and urgent cardiology consultation. Given the recent surgery, the timing and approach to anticoagulation and antiplatelet therapy must be carefully balanced against bleeding risk. Emergency PCI is reserved for haemodynamically unstable patients or those with ongoing ischaemia despite medical therapy.

Reference: NICE – 2020 – NG185 Acute coronary syndromes; RCOA – 2023 – Perioperative cardiac events