NSTEMI and Unstable Angina MCQ — NEET PG Practice Question | NEETPGAI
NSTEMI and Unstable Angina
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stethoscope Medicine
A 58-year-old man from Delhi presents with acute chest pain at rest for 2 hours, radiating to the left arm. His ECG shows ST-segment depression in leads II, III, aVF, and V4–V6 with T-wave inversion. Troponin I is elevated at 0.8 ng/mL (normal <0.04). Regarding the management of this NSTEMI, all of the following are appropriate EXCEPT:
A. Beta-blocker (e.g., metoprolol 25 mg) and ACE inhibitor (e.g., lisinopril 5 mg) for symptom relief and cardioprotection
B. Immediate thrombolytic therapy (streptokinase or alteplase) as first-line reperfusion strategy
C. Immediate dual antiplatelet therapy with aspirin 300 mg and ticagrelor 180 mg loading dose
D. Unfractionated heparin or enoxaparin for anticoagulation to prevent thrombotic extension
Explanation
Management of NSTEMI: Reperfusion Strategy
Key Point
NSTEMI management centers on antiplatelet therapy, anticoagulation, and coronary angiography with percutaneous coronary intervention (PCI) — NOT thrombolytic therapy.
Reperfusion Strategy in NSTEMI vs. STEMI
Table
Condition
Reperfusion Strategy
Rationale
STEMI
Immediate PCI or thrombolysis
Complete coronary occlusion; time-critical to restore flow
NSTEMI
Coronary angiography + PCI (not thrombolysis)
Partial occlusion; angiography identifies culprit lesion; PCI is superior to thrombolysis
Unstable Angina
Coronary angiography ± PCI
No myocardial necrosis; angiography guides intervention
High-YieldNEET PG
Thrombolytic therapy is NOT indicated in NSTEMI. Thrombolytics are reserved for STEMI when PCI is not available within 120 minutes.
Why Thrombolysis Is Inappropriate in NSTEMI
1.
Partial occlusion — NSTEMI results from partial coronary occlusion; the vessel is already partially patent. Thrombolytics risk distal embolization without achieving optimal reperfusion.
2.
Evidence-based practice — Multiple trials (e.g., TIMI IIIB, FRISC II) demonstrate that early invasive strategy (angiography + PCI) is superior to thrombolysis in NSTEMI.
3.
Increased bleeding risk — Thrombolytics in NSTEMI increase major bleeding without mortality benefit.
4.
Angiography is diagnostic — Coronary angiography identifies the culprit lesion, assesses collaterals, and guides PCI or medical therapy.
Clinical Pearl
The management paradigm for NSTEMI is "diagnose and revascularize," not "lyse and hope." Early invasive strategy (angiography within 24–72 hours, or earlier in high-risk patients) is the standard of care.
