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Non-ST-elevation myocardial infarction

Last reviewed: 6 Nov 2023
Last updated: 25 Jul 2023



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 presentation





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

Director, Cardiac MRI

Clinical Professor of Medicine and Radiology

Division of Cardiology

Department of Internal Medicine

University of Iowa Hospitals and Clinics

University of Iowa Health Care




MLA declares that she is a member of the Board of Governors 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




SG declares that he is Senior Director of Medical Strategy and Innovation for the US market at Philips. SG is a senior advisor at Emeritus. SG is a voluntary board member of the American College of Cardiology (ACC) National Cardiovascular Data Registry oversight committee, the Chest Pain Myocardial Infarction registry steering committee, and the ACC finance committee.


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.


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




SWY declares that he has no competing interests.

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