Non-ST-elevation myocardial infarction
Summary
Definition
History and exam
Key diagnostic factors
- chest pain
- risk factors for cardiovascular disease
- marked sweating
- cardiogenic shock
- acute heart failure
Other diagnostic factors
- nausea and vomiting
- arrhythmias
- heart murmur
- epigastric pain
- dyspnoea
- syncope
- back pain
Risk factors
- atherosclerosis (history of angina, myocardial infarction, stroke, transient ischaemic attack, peripheral vascular disease)
- diabetes
- smoking
- dyslipidaemia
- family history of premature coronary artery disease (CAD)
- age >65 years
- hypertension
- obesity and metabolic syndrome phenotype
- physical inactivity
- cocaine use
- depression
- stent thrombosis or restenosis
- chronic kidney disease
- surgical procedures (including intra-operative and postoperative periods)
- sleep apnoea
Diagnostic investigations
1st investigations to order
- ECG
- high-sensitivity troponin
- chest x-ray
- full blood count
- urea, electrolytes, and creatinine
- liver function tests
- blood glucose
- C-reactive protein
Investigations to consider
- echocardiography
- invasive coronary angiography (ICA)
Treatment algorithm
clinically unstable (suspected or confirmed NSTEMI)
clinically stable (suspected or confirmed NSTEMI)
post-stabilisation
Contributors
Expert advisers
Resham Baruah, MBBS, BSc MRCP, PhD
Consultant Cardiologist
Chelsea and Westminster Hospital NHS Foundation Trust
Royal Brompton & Harefield NHS Foundation Trust
London
UK
Biography
RB is specialist advisor to the 2018 NICE guideline on chronic heart failure in adults and is a member of the European Heart Failure Association Task Force on palliative care in heart failure.
Disclosures
RB has received honoraria/speakers’ fees from Novartis and Boehringer Ingelheim.
Adam Hartley, MBBS, BSc, MRCP
Wellcome Trust Clinical Research Fellow
Imperial College London
Specialist Registrar in Cardiology
Imperial College Healthcare NHS Trust
London
UK
Disclosures
AH declares that he has no competing interests.
Acknowledgements,
BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:
Cody S Deen, MD
Assistant Professor of Medicine
Director of Cardiology
Hillsborough Hospital
University of North Carolina
Hillsborough
NC
Disclosures
CSD was previously the Director of Cardiac Rehab for Chatham Hospital, which was financially set up as a consultancy relationship, until 2017. CSD has spoken (unpaid) at the Update in Cardiology and Update in Internal Medicine Conferences at UNC for the last 5 years. CSD has served as the PI for the Dal-GeneE (site now closed) and the ACCELERATE Trials at the University of North Carolina (trial now completed). Each trial required paid travel to an investigator meeting.
Peer reviewers
Gavin Galasko, BM, BCh, MA, DM (Oxon), FRCP
Consultant Interventional Cardiologist
Director of Research, Development and Innovation
Blackpool Teaching Hospitals NHS Foundation Trust
Blackpool
UK
Disclosures
GG declares that he has no competing interests.
Editors
Annabel Sidwell,
Section Editor, BMJ Best Practice
Disclosures
AS declares that she has no competing interests.
Susan Mayor,
Lead Section Editor, BMJ Best Practice
Disclosures
SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.
Rachel Wheeler,
Lead Section Editor, BMJ Best Practice
Disclosures
RW declares that she has no competing interests.
Julie Costello,
Comorbidities Editor, BMJ Best Practice
Disclosures
JC declares that she has no competing interests.
Adam Mitchell,
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
Differentials
- ST-elevation myocardial infarction
- Unstable angina
- Aortic dissection
More DifferentialsGuidelines
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