QuestionSBA
QuestionChoice
This is incorrect - unstable angina is diagnosed when biomarkers (e.g. troponin) are not raised. In this case, the baseline troponin was raised, and there is evidence that it is rising further.
10028302
b
Unstable angina
QuestionChoice
While this is correct, acute coronary syndrome (ACS) does not best describe the diagnosis. ACS encompasses ST elevation myocardial infarctions, Non-ST elevation myocardial infarctions, and unstable angina.
10028303
c
Acute coronary syndrome
QuestionChoice
This is the correct answer, as the patient has classic cardiac chest pain, a raised (and rising) troponin, and evolving ECG changes (but without ST elevation). It is important to note that even if the ECG remained normal, this would still be categorised as an NSTEMI due to the troponin rise.
10028301
a
Non-ST elevation myocardial infarction (NSTEMI)
QuestionChoice
This is incorrect; stable angina is  characterised by exertional chest pain that is fully relieved by rest and/or nitrate therapy. It is not associated with dynamic ECG changes or rising cardiac biomarkers.
10028304
d
Stable angina
QuestionChoice
This is incorrect; there is no evidence of ST elevation on the ECGs. This is a non-ST elevation myocardial infarction.
10028305
e
ST elevation myocardial infarction
QuestionComment
Unstable angina - normal troponin
STEMI / NSTEMI - raised troponin 
T wave inversion is a feature seen only with NSTEMI and unstable angina 
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Edema Dominant
QuestionComment
Is there not ST elevation in VI and VII? And then I thought the T wave inversion were reciprocal changes in opposite leads? Please help :(((
59503
QuestionComment
I think the size of the ST elevation isn't enough, it has to be >2 small squares taller than the top of the P wave i think
60702
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Embolism Bladder
QuestionComment
yeah this should be STEMI as ST elevation in V1. Only need >2mm in v2 and v3 otherwise its >1mm
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Sydney Sweeney
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Thermoregulator Relapse
Concept
Chapter
2693
6049
Interpretation of Troponin rise in the Emergency Setting
Topic
161
Emergency Medicine
18058
Non-ST elevation myocardial infarction (NSTEMI) is characterised by elevated troponin levels and typical chest pain without ST segment elevation on ECG.
Picture
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Topic
161
Emergency Medicine
A 66-year-old man with a background of diabetes and hypertension arrives at the emergency department with central, crushing chest pain.


His initial ECG shows:
 [lightgallery]


Repeat ECGs show some evolving T wave inversion in the inferior leads.


His symptoms are somewhat relieved by GTN spray and morphine. He has received 300mg aspirin and a loading dose of clopidogrel.


High-sensitivity troponin T levels:
 1st sample - 54 ng/L (<10 ng/L)
 2nd sample - 232 ng/L (<10 ng/L)


Which term best describes the diagnosis?
a