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NSTEMI — RCPSC IM MCQ

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HardCardiologyNSTEMIRCPSC IM

A 68-year-old man presents with 3 hours of central chest pressure radiating to his left arm. The ECG shows 1.5 mm horizontal ST depression in V4-V6 and high-sensitivity troponin rises from 36 to 210 ng/L over 2 hours. He has ongoing pain despite nitroglycerin, blood pressure is 96/58 mm Hg, and bedside echocardiography shows new anterior hypokinesis without pericardial effusion. What is the most appropriate management?

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Correct answer: C — Urgent coronary angiography with intent to revascularise

Dynamic ischemic ECG changes, rising troponin, ongoing symptoms and hemodynamic compromise define high-risk non-ST elevation acute coronary syndrome. The appropriate strategy is early invasive angiography with antithrombotic therapy unless contraindicated; fibrinolysis is not used for NSTEMI.

Reference: Canadian Cardiovascular Society acute coronary syndrome guidance; ESC/ACC NSTEMI guidance