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Non-ST-elevation myocardial infarction — SCE Acute Medicine MCQ

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EasyAcute Cardiac PresentationsNon-ST-elevation myocardial infarctionSCE Acute Medicine

A 66-year-old woman is assessed on the acute medical unit. She has recurrent chest tightness at rest and diabetes. Initial ECG shows T-wave inversion in V2-V5 and the first troponin is borderline. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate investigation?

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Correct answer: C — Twelve-lead ECG and serial high-sensitivity troponin

Twelve-lead ECG and serial high-sensitivity troponin is the best answer because serial ECG and high-sensitivity troponin testing distinguish dynamic myocardial injury and guide early invasive risk stratification. CT angiography of the aorta is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: A single early troponin can be misleading.

Reference: NICE NG185