← Diagnosis and Management Guides
NSTEMI / Unstable Angina
Key considerations: STEMI evolution, Aortic dissection, Myocarditis
Cannot miss
- STEMI evolution
- Aortic dissection
- Myocarditis
Likely diagnoses
- NSTEMI
- Unstable angina
- Demand ischemia
Red flags
- Dynamic ECG changes
- Rising troponins
- Hemodynamic instability
Workup
- history: Chest pain character, duration, exertional, prior CAD; exam: Heart sounds, signs of CHF; labs: Serial troponins 0/3hr, CBC, BMP, coags; imaging: CXR, echo if new murmur or CHF; bedside: Serial ECGs
Management
- immediate: Aspirin 324mg, heparin, P2Y12 inhibitor per cardiology; general: Beta-blocker, statin, nitrates for ongoing pain; Early invasive strategy (<24hr) for high-risk features
Disposition
- admit: All NSTEMI patients to monitored bed; Cardiology consult for cath timing; discharge: Only after risk stratification and cardiology clearance; consults: Cardiology
Clinical pearls
- HEART score ≥7 = high risk, should get early invasive strategy
- Troponin-negative unstable angina still warrants admission if high clinical suspicion
Source and review
- AHA/ACC NSTE-ACS Guidelines 2014. Last reviewed: 2024-11-01