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Acute Coronary Syndrome: Non–Q-Wave (Non–ST-Elevation) MI, Emergency Medicine

Reviewed 06/2017



  • Non–ST-elevation myocardial infarction (NSTEMI) is a part of a clinical syndrome that also includes unstable angina and ST-elevation MI (STEMI).

  • Caused by subtotal occlusion of corona...


Signs and Symptoms


  • Pain:

    • Pressure or tightness or heaviness

    • Substernal, epigastric

    • +/– radiation to arm, jaw, back

    • More likely nonpositional, nonpleuritic, nonreproducible on palpation

  • Naus...



  • IV access

  • Oxygen administration

  • 12-lead EKG, cardiac monitoring, and treatment of arrhythmias

  • Aspirin, analgesia, anxiolytics

Initial Stabilization/Therapy

  • Oxygen administration

  • IV acc...



Admission Criteria

  • All patients with positive cardiac biomarkers, high risk for adverse outcomes by clinical prediction rules (TIMI, GRACE, PURSUIT), or significant clinical probab...

Pearls and Pitfalls

  • EKG should be done in all patients with chest pain on arrival to the ED, preferably within 10 min.

  • Early medical therapy can reduce mortality in NSTEMI.

  • Pitfalls:

    • Do not rule out infa...

Additional Reading

  • Anderson  JL, Adams  CD, Antman  EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction. J Am Coll Cardiol. &#...



  • 410.70 Subendocardial infarction, episode of care unspecified

  • 410.71 Subendocardial infarction, initial episode of care

  • 410.72 Subendocardial infarction, subsequent episode of care

  • 411.1 Interm...

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