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

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...

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

Oxygen administration

IV acc...

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

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...

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...