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Non-ST elevation myocardial infarction — RCPSC EM MCQ

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ModerateCardiovascular emergenciesNon-ST elevation myocardial infarctionRCPSC EM

A 63-year-old woman has chest pressure at rest, diaphoresis and dynamic ST depression in V4-V6. Initial troponin is normal, repeat at two hours is elevated. Blood pressure is 146/82 mmHg and there is no heart failure. What is the most appropriate initial management?

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Correct answer: E — Treat as non-ST elevation acute coronary syndrome with antiplatelet and anticoagulant strategy and admit for early invasive risk assessment

Dynamic ischaemic ECG changes and rising troponin indicate NSTEMI. Management includes anti-ischaemic therapy, antithrombotic strategy, risk stratification and admission for cardiology assessment.

Reference: Canadian Cardiovascular Society acute coronary syndrome guidance; ACLS