30th May 2026

Diagnosis

Investigations

• ECG: 12-lead within 10 minutes; may show ST depression, T-wave inversion, or transient ST elevation.
• Troponin: Dynamic elevation confirms NSTEMI. 
  • Diagnosis requires rise/fall with ≥99th percentile value.
  • Use rapid rule-in/rule-out algorithms (ESC 0/1h or 0/3h) where validated.
  • Large elevations (>5× URL) indicate acute Type-1 MI and higher risk.
• Other tests: Chest X-ray, blood tests (FBC, U&E, LFTs, glucose, CRP), and echocardiography if heart failure or instability is suspected.
• Risk Pathways: Use troponin levels and repeat testing to guide management.

Clinical Manifestations

Chest pain >15 minutes, new/worsened, accompanied by nausea, sweating, breathlessness, or hemodynamic instability. Risk factors include diabetes, renal dysfunction, hypertension, smoking, a family history of coronary artery disease, a sedentary lifestyle, and obesity. Red flags include hemodynamic instability, acute LV failure, or arrhythmias.