NSTEMI is part of a wide spectrum ranging from unstable angina to stemi. I am going to focus on how to identify the patient and to manage them
Spectrum of ACS with its features
ACC - 99th percentile cutoff for a healthy patient population WHO – Coefficient variance 10%
U&E = urea & electrolytes Clopidogrel? GTN 600mg as needed
The heart rhythm must be supraventricular in origin The QRS duration must be ≥ 120 ms [2] There should be a QS or rS complex in lead V1 There should be a RsR' wave in lead V6.
The T wave should be deflected opposite the terminal deflection of the QRS complex. This is known as appropriate T wave discordance with bundle branch block. A concordant T wave may suggest ischemia or myocardial infarction.
Inflation of balloon or stent into coronary artery, which crushed the plaque into the wall and dilate the lumen Normal flow is restored
Silent ischemia : ST changes at rest without angina. Exercise testing:12 lead ECG recorded during exercise on a treadmill or bicycle ergometer. Limb leads are placed on shoulders and hips instead of wrist and ankle. Low bp, exercise induced arrhythmia ,prolonged ischemic ECG changes suggestive of high risk findings Follow BRUCE protocols that have 5 stages to classified ischemia and it depends on speed and % of inclination of the treadmill.
