Unstable Angina and NSTEMI

Chest pain in unstable angina and NSTEMI resembles stable angina but is more severe, occurs at rest and lasts longer (up to 30 minutes). The chest pain is often associated with nausea, sweatiness, dyspnea, palpitations.

Investigations

BLI, ECG ( to look for ischemic changes ), CXR ( to look for cardiomegaly, pulmonary edema etc. ) cardiac biomarkers / enzymes abnormalities ) coronary angiography Perform diagnostic workup to Troponin- & 7 ) Echocardiography ( to look for regional wall exclude MI in all patients.

Essentials of diagnosis

ECG shows ST - segment deviation (> 0.5mm ) or new T - wave inversions ( only during pain in case of unstable angina ). Both unstable angina and NSTEMI lack ST segment elevations and pathologic Q waves.NSTEMI is distinguished from unstable angina by the presence of elevated serum levels of cardiac biomarkers ( troponins and CK MB ). If there are no detectable serum markers of myocardial injury 12- 18 hours after symptom onset, the patient should be diagnosed with unstable angina.

Management

• Admit the patient in ICU or CCU for monitoring and pass IV line
• Bed rest and reassurance
• Oxygen inhalation stat if SPO2 < 92 % then SOS
• ECG monitor & rhythm strip
• Inj- Morphine (dilute 10mg in to 10 mL N / S 0.9 %) 1-2 mg / minute x Stat. OR Inj- Nalbuphine + Dimenhydrinate (Nalbin + Gravinate) IV x stat
• Tab- Glyceral Trinitrate (Angised) 0.5mg 1 tab S / L x Stat Repeat every 10-15 minutes
• Tab- Aspirin (Disprin) 300mg 1 tab PO x stat
• Tab- Clopidogrel (Noclot - LD) 300mg 1 tab PO x stat
• Inj- Fondaparinux (Arixtra) 2.5-5mg S / C X OD contraindicated in renal diseases) ' OR '
• Inj- Enoxaparin (Clexane) 60mg S / C x BD for 3 days (OD dose in renal diseases)
• Tab - Carvideolol (Carveda) 6.25-25mg 1 tab PO x BD ' OR '
• Tab-Metoprolol (Merol) 12.5-50mg 1 tab PO X OD
• Tab – Rimipril (Ramipace) 1.25-5mg 1 tab PO x OD