Non-ST-elevation myocardial infarction

Last reviewed: 22 Feb 2023
Last updated: 09 Feb 2023

Summary

Definition

History and exam

Key diagnostic factors

  • chest pain
  • diaphoresis
More key diagnostic factors

Other diagnostic factors

  • shortness of breath
  • weakness
  • anxiety
  • nausea and vomiting
  • abdominal pain
  • hypertension
  • early morning onset
  • syncope
  • hypotension
  • arrhythmias
  • abnormal heart sounds
Other diagnostic factors

Risk factors

  • atherosclerosis (history of angina, myocardial infarction, stroke, transient ischemic attack, peripheral vascular disease)
  • diabetes
  • smoking
  • dyslipidemia
  • 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 intraoperative and postoperative periods)
  • sleep apnea
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • cardiac biomarkers
  • echocardiography
  • CBC
  • BUN and serum creatinine
  • electrolytes
  • LFTs
  • blood glucose
  • chest x-ray
More 1st investigations to order

Investigations to consider

  • lipids
  • brain natriuretic peptide (BNP) or N-terminal pro-BNP (NT-pro-BNP)
  • angiography/cardiac catheterization
  • stress testing
  • coronary CT angiography (CCTA)
More investigations to consider

Treatment algorithm

ACUTE

acute presentation

ONGOING

post-stabilization

Contributors

Authors

Mahi L. Ashwath, MD, MBA, FACC, FASE, FSCMR

Director, Cardiac MRIClinical Professor of Medicine and Radiology

Division of Cardiology

Department of Internal Medicine

University of Iowa Hospitals and Clinics

University of Iowa Health Care

Iowa

IA

Disclosures

MLA declares that she is the Governor for the Iowa Chapter of the American College of Cardiology.

Sanjay Gandhi, MD, MBA, FACC, FAHA, FSCAI

Director, Endovascular Cardiology

Professor of Medicine, Endovascular Cardiology

Case Western Reserve University

Cleveland

OH

Disclosures

SG declares that he has no competing interests.

Acknowledgements

Dr Mahi L. Ashwath and Dr Sanjay Gandhi would like to gratefully acknowledge Dr Cody Deen, Dr Sripal Bangalore, Dr Mina Owlia, Dr Thomas Vanhecke, and Dr Dena Krishnan, the previous contributors to this topic.

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. SB, MO, TV, and DK declare that they have no competing interests.

Peer reviewers

Syed Wamique Yusuf, MBBS, FRCPI

Professor of Medicine

Department of Cardiology

University of Texas

MD Anderson Cancer Center

Houston

TX

Disclosures

SWY declares that he has no competing interests.

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