Myocardial Infarction, UA/NSTEMI

Jaw pain

Step 1: View clinicals

A 63 year old lady presents with continuous jaw pain for 20 minutes which was acute in onset and dull and aching in nature. During the preceding few months, she had experienced several episodes of jaw pain following exertion. She was diagnosed with diabetes and hypertension 9 and 6 years ago respectively. She does not smoke. An ECG performed a week ago was normal.


Step 2: Order all relevant investigations

ECG

There are deep symmetric T-inversions in leads II, III, and AvF

Troponin-T assays

The Troponin-T assays at admission and at 12 hours are both negative.

Exercise ECG stat

You realize that performing an exercise ECG right now might be a bad idea.

Echocardiogram

The echocardiogram shows a left ventricular ejection fraction of 65% with no regional wall motion abnormalities and mild diastolic dysfunction. The left ventricular volume is normal.


Step 3: Select appropriate management

Ibuprofen
Enoxaparin
Reteplase
Coronary angioplasty stat


Score: ★★☆