Non-ST-Segment Elevation MI: The Daily PANCE Blueprint

Non-ST-Segment Elevation MI: The Daily PANCE Blueprint

Which of the following is NOT true about a non-ST elevation myocardial infarction?

A. Non-enteric-coated, chewable aspirin 325 mg should be given
B. Troponins are elevated
C. It happens due to a partially occluded epicardial coronary artery
D. Patients need a 12-lead EKG
E. You will always see ST depressions

Answer and topic summary

The answer is E. You will always see ST depressions

A non-ST elevation myocardial infarction (NSTEMI) is defined by the absence of persistent ST-elevation with elevated cardiac biomarkers (e.g., troponin I or T, CKMB, etc). It happens due to a partially occluded epicardial coronary artery (leading to subendocardial ischemia). NSTEMI typically presents as pressure-type chest pain.

Patients with a suspected NSTEMI should receive a 12-lead EKG within 10 minutes of arrival. ST depression, transient ST-elevation, and/or T-wave inversions may be seen on EKG, but they are NOT required for the diagnosis of NSTEMI. The most important medication to give is non-enteric-coated chewable aspirin 325 mg. Other meds include sublingual nitroglycerin, oxygen as needed, beta-blockers (assuming no C/I), high-intensity statin, ACE inhibitors (if CKD, DM, or EF < 40%), P2Y12 inhibitor (e.g., clopidogrel), anticoagulation, and possibly PCI with stenting or CABG.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint CardiologyCoronary Heart DiseaseAcute myocardial infarctionNon-ST-Segment Elevation MI (NSTEMI)

Also covered as part of the Family Medicine EOR, Internal Medicine EOR, Emergency Medicine EOR topic list

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