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High-risk NSTEMI — SCE Acute Medicine MCQ

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EasyAcute Cardiac PresentationsHigh-risk NSTEMISCE Acute Medicine

A 73-year-old man presents with acute chest symptoms with haemodynamic concern. Relevant history includes cardiovascular risk factors or structural heart disease. On assessment, haemodynamic findings and ECG changes are present. Investigations show dynamic ST depression with rising troponin and recurrent rest pain. What is the most appropriate next step in management?

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Correct answer: C — Treat as high-risk NSTEMI and arrange early invasive coronary angiography

The key discriminator is that dynamic ST depression with rising troponin and recurrent rest pain, which makes Treat as high-risk NSTEMI and arrange early invasive coronary angiography the single best answer. Give targeted antidote or reversal therapy is less appropriate because it does not address the dominant acute risk in the vignette; Arrange routine outpatient follow-up would fit a different presentation or later stage of care. Start anticoagulation after assessing bleeding risk and Start broad-spectrum intravenous antibiotics are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE NG185