NSTEMI
Part of acute coronary syndrome - CC1
clinical presentation
- Like unstable angina, pain at rest
- Must have dynamic troponin rise
main ecg patterns
Unlike STEMI, can't localise the lesion well from the ECG
ST depression
- horizontal or downsloping > 0.5mm in 2 or more contiguous leads
T wave inversion
- be present in ≥ 2 contiguous leads that have dominant R waves (R/S ratio > 1)
- be dynamic
- be at least 1 mm deep
not very specific if found in leads III, aVR and V1.
misc
- hyperacute T waves or normalisation of previously inverted T waves
- U wave inversion
management principles
- Aspirin loading
- Fondaparinux, unless angio can be offered within 24h
Invasive coronary angio within 24 hours if at least one of the below:
- A confirmed diagnosis of NSTEMI based on current recommended European Society of Cardiology (ESC) high-sensitivity cardiac troponin (hs-cTn) algorithms
- Dynamic ST-segment or T-wave changes
- Transient ST-segment elevation
- A GRACE risk score >140