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

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ModerateAcute Cardiac PresentationsNon-ST-elevation myocardial infarctionSCE Acute Medicine

A 74-year-old woman presents with chest tightness that settled after 40 minutes. ECG shows dynamic T-wave inversion in V2 to V5 and high-sensitivity troponin rises from 48 to 186 ng/L. eGFR is 52 mL/min/1.73 m2 and there is no active bleeding. What is the most appropriate next step in management?

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Correct answer: D — Admit for NSTEMI management with antithrombotic therapy and early invasive risk assessment

The dynamic ECG changes and troponin rise establish NSTEMI, requiring inpatient antithrombotic therapy and risk-stratified invasive assessment. Symptom resolution does not make the event low risk. Fibrinolysis is not used for NSTEMI. A key point is that troponin positivity changes the pathway from stable chest pain investigation to acute coronary syndrome care.

Reference: NICE NG185, ESC NSTE-ACS guideline, BNF