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Non-ST-elevation myocardial infarction — RCPSC IM MCQ

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HardCardiologyNon-ST-elevation myocardial infarctionRCPSC IM

A 68-year-old man in Toronto has 90 minutes of central chest pressure radiating to the left arm. His ECG shows 2 mm ST depression in V4-V6 and T-wave inversion in I and aVL. High-sensitivity troponin rises from 58 to 412 ng/L over 3 hours. Blood pressure is 142/86 mmHg, creatinine is 96 micromol/L, and he has no bleeding history. What is the most appropriate investigation?

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Correct answer: E — Early invasive coronary angiography after initiation of antithrombotic therapy

High-risk NSTEMI with dynamic troponin rise and ischemic ECG changes warrants early invasive coronary angiography after standard initial medical therapy.

Reference: Canadian Cardiovascular Society acute coronary syndrome guidance; Royal College Internal Medicine competencies