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Acute Coronary Syndromes: NSTE-ACS (Unstable Angina and NSTEMI)

Asma Tariq, M.D, Jared Caballes, MD and Daniela Rangel Orozco, MD, MHP, MS Reviewed 04/2024
 


BASICS

DESCRIPTION

  • Unstable angina (UA) and non–ST-segment elevation myocardial infarction (NSTEMI) are acute coronary syndromes without ST-segment elevation (NSTE-ACS) that are differentiated from one...

DIAGNOSIS

HISTORY

  • Chest heaviness/tightness lasting ≥10 minutes; with or without exertion, typically retrosternal and can radiate to the neck, jaw, interscapular area, upper extremities, or epigastrium...

TREATMENT

GENERAL MEASURES

  • Initial ABCDs, assess clinical stability (adequate oxygenation) and determine next step

  • Risk stratify (TIMI or GRACE score) to select invasive approach (coronary angiography w...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Patients with low-risk suspected ACS who have normal serial ECGs and cardiac troponin levels may have a treadmill ECG, stress myocardial perfusion imaging, or str...

REFERENCES

1
Amsterdam EA, Wenger NA, Brindis RG, et al. AHA/ACC Guidelines for the Management of Patient with Non-ST-Elevation Acute Coronary Syndrome. J Am Coll Cardiol. 2014;64(24):e344–e426.

CODES

ICD10

  • I24.9 Acute ischemic heart disease, unspecified

  • I20.0 Unstable angina

  • I21.4 Non-ST elevation (NSTEMI) myocardial infarction

SNOMED

  • 394659003 Acute coronary syndrome (disorder)

  • 4557003 Preinfarct...

CLINICAL PEARLS

  • NSTEMI is diagnosed in patients who present with symptoms consistent with ACS and elevated troponin levels, but without EKG changes suggestive of STEMI.

  • UA can present similarly to NSTE...

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