QuestionSBA
QuestionChoice
This patient is presenting with signs and symptoms characteristic of acute coronary syndrome (ACS). As no regions of ST-elevation are seen on the ECG, this man is likely experiencing a non-ST-elevation myocardial infarction (NSTEMI). The most widely used scoring system for NSTEMIs is the GRACE score which takes into account the patient's age, heart rate/blood pressure, cardiac function, renal function, ECG findings and troponin levels to calculate the predicted 6-month mortality. If the GRACE score is greater than 3% (or if the patient is haemodynamically unstable), percutaneous coronary intervention should be the mainstay treatment. If the GRACE score is less than 3%, conservative management may be trialled, usually with ticagrelor in the first instance.
10002302
a
GRACE score
QuestionChoice
The CHA₂DS₂-VASc score is used to calculate the stroke risk in patients with atrial fibrillation. It is not useful in calculating the risk of 6-month mortality in patients with NSTEMIs.
10002304
c
CHA₂DS₂-VASc score
QuestionChoice
The Duke criteria are a set of clinical criteria used to calculate the probability of a patient having infective endocarditis.
10002306
e
Duke criteria
QuestionChoice
The HAS-BLED score is used to calculate the one-year risk of major bleeding in patients with atrial fibrillation who are taking anticoagulant therapy.
10002305
d
HAS-BLED score
QuestionChoice
The Wells score is used to calculate the clinical probability of a patient having a pulmonary embolism. A pulmonary embolism would classically present with pleuritic chest pain, tachycardia and a history of recent physical inactivity. There may also be S1Q3T3 changes on an ECG, meaning a large S wave in lead I, a Q wave in lead III, and an inverted T wave in lead III.
10002303
b
Wells score
Concept
Chapter
2693
3802
Myocardial Infarction
Topic
134
Cardiology
13007
A 72-year-old male presents to the Emergency Department with acute onset central crushing chest pain radiating to the left shoulder. He has a past medical history of hypertension, type 2 diabetes and hypercholesterolaemia.

The patient's observations are currently as follows: heart rate 83 bpm regular, blood pressure 138/78 mmHg, respiratory rate 18 breaths/minute, SpO2 95% on air, temperature 37.5 degrees Celsius.

An ECG is performed which reveals no regions of ST-elevation, although there is some T-wave inversion seen in leads I and avL.

Given the most likely diagnosis, which of the following scoring systems should be used to help determine the management plan?
a