Non-ST-elevation myocardial infarction

Last reviewed: 3 Nov 2022
Last updated: 18 Aug 2022



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





Cody S. Deen, MD

Assistant Professor of Medicine

Director of Cardiology

Hillsborough Hospital

University of North Carolina




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.


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


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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