From the Guidelines
When rounding on a patient with NSTEMI, you should ask about their risk stratification based on features such as history, character of pain, clinical findings, ECG, and cardiac markers, as outlined in the 2012 ACCF/AHA guidelines 1. To assess the patient's risk, inquire about their history of accelerating tempo of ischemic symptoms, prior MI, peripheral or cerebrovascular disease, or CABG, as these are high-risk features. Also, ask about the character of their pain, including prolonged ongoing rest pain, rest angina, or nocturnal angina, as these are indicative of high or intermediate risk. Clinical findings such as pulmonary edema, new or worsening MR murmur, hypotension, bradycardia, or tachycardia should also be assessed, as they are associated with high risk. ECG changes, including angina at rest with transient ST-segment changes, bundle-branch block, or sustained ventricular tachycardia, are also important to evaluate. Cardiac markers, such as elevated cardiac TnT, TnI, or CK-MB, should be reviewed to assess the patient's risk of death or nonfatal MI. Some key questions to ask when rounding on a patient with NSTEMI include:
- What is the patient's history of ischemic symptoms, and have they experienced any recent changes?
- What is the character of their chest pain, and has it changed since admission?
- Are there any clinical findings that suggest high or intermediate risk, such as pulmonary edema or hypotension?
- What are the patient's ECG changes, and have they been evaluated by a cardiologist?
- What are the patient's cardiac biomarker levels, and have they been trending upwards or downwards?
- Is the patient receiving appropriate medications, including dual antiplatelet therapy, anticoagulation, beta-blockers, and high-intensity statins?
- Are there any plans for cardiac catheterization, and have the results been discussed with the patient and their family? These questions help assess the patient's clinical status, treatment efficacy, and guide management decisions for this acute coronary syndrome, as recommended by the 2012 ACCF/AHA guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Rounding on NSTEMI: Key Questions to Ask
When rounding on patients with Non-ST-Elevation Myocardial Infarction (NSTEMI), several key questions should be asked to ensure optimal care and management. These questions include:
- What is the patient's current symptoms and medical history, including any comorbidities that may impact treatment decisions 2?
- What are the results of the patient's electrocardiogram (ECG), cardiac biomarkers, and other diagnostic tests, such as coronary computed tomography angiography (CCTA) 3?
- Has the patient been risk-stratified, and what is their individualized risk assessment 2?
- What pharmacologic therapies, such as anti-anginal, anticoagulant, and antiplatelet medications, has the patient been prescribed, and are they being managed according to published guidelines 2, 3?
- Has the patient undergone percutaneous coronary intervention (PCI), and if so, what were the results 4, 5?
- What are the patient's vital signs, and are they showing any signs of complications, such as cardiogenic shock or heart failure 6, 5?
- Are there any plans for further testing or procedures, such as stress testing or coronary artery bypass grafting (CABG) 2, 4?
- What is the patient's current medication regimen, and are there any potential interactions or side effects that need to be monitored 2, 3?
- Are there any social or environmental factors that may impact the patient's recovery or adherence to treatment, such as access to follow-up care or support systems 2?
Additional Considerations
Additional considerations when rounding on NSTEMI patients include:
- Distinguishing between type 1 and type 2 NSTEMI, as they have different underlying etiologies and may require different management strategies 6
- Considering the timing of PCI and its potential impact on outcomes, including the risk of major adverse cardiac events (MACE) 5
- Monitoring for potential complications, such as bleeding or thrombotic events, and adjusting treatment accordingly 2, 3
- Ensuring that the patient is receiving evidence-based care, including guideline-recommended therapies and interventions 2, 3, 4