NSTEMI and Unstable Angina MCQ — NEET PG Practice Question | NEETPGAI
NSTEMI and Unstable Angina
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stethoscope Medicine
A 62-year-old woman from Mumbai with a history of hypertension and smoking presents to the emergency department with 2 episodes of chest pain over the past 6 hours, each lasting 15–20 minutes and relieved by rest. The most recent episode occurred 30 minutes ago. She denies dyspnea or diaphoresis. Vital signs are stable: BP 135/88 mmHg, HR 78 bpm. Physical examination is unremarkable. 12-lead ECG shows T-wave inversion in leads V2–V4. Troponin I measured at presentation is <0.01 ng/mL (normal). Repeat troponin 3 hours later is also <0.01 ng/mL. What is the most likely diagnosis?
A. Stable angina
B. NSTEMI
C. Unstable angina
D. Atypical chest pain
Explanation
Clinical Presentation Analysis
Key Features of This Case
1.
Recurrent chest pain at rest (2 episodes in 6 hours, each 15–20 minutes)
2.
T-wave inversion on ECG (anterior leads V2–V4) — indicates ischemia
3.
Negative troponins at presentation and 3 hours (serial troponins remain <0.01 ng/mL)
4.
Stable vital signs and minimal symptoms (no diaphoresis)
Differential Diagnosis: ACS Spectrum
Table
Feature
Stable Angina
Unstable Angina
NSTEMI
Chest pain pattern
Predictable, exertional
New onset or at rest; increasing frequency/severity
Prolonged, at rest
Troponin
Negative
Negative
Positive
ECG changes
Normal or old changes
ST depression, T-wave inversion
ST depression, T-wave inversion
Pathophysiology
Fixed stenosis
Plaque rupture without necrosis
Plaque rupture with myocardial necrosis
High-YieldNEET PG
The defining feature of unstable angina is troponin-negative ACS with dynamic ischemic ECG changes. This patient fits perfectly: T-wave inversion (ischemia) but no troponin elevation (no necrosis).
Why This Is Unstable Angina
Key Point
Unstable angina represents acute coronary syndrome without myocardial necrosis. It is diagnosed when:
1.
Clinical features of ACS are present (chest pain, recurrent episodes, pain at rest)
T-wave inversion in anterior leads (V2–V4) suggests anterior wall ischemia from left anterior descending (LAD) artery disease. The absence of troponin elevation indicates that ischemia has not yet progressed to irreversible myocardial necrosis.
Mnemonic: UA = ACS without Troponin = Unstable Angina
Early invasive strategy (coronary angiography within 24 hours)
4.
Beta-blockers, ACE inhibitors, statins for secondary prevention
Unlike NSTEMI, unstable angina does NOT show myocardial necrosis, but it carries significant risk of progression to MI and requires urgent coronary angiography to identify and treat the culprit lesion.
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