ECG Diagnosis
Biomarkers
NSTEMI Management
STEMI Treatment
ABIM Board Pearls
100

This ECG finding defines STEMI when present in two contiguous leads with appropriate millimeter criteria.

What is ST-segment elevation?

Teaching Pearl

  • STEMI = acute coronary occlusion until proven otherwise.
  • Remember lead-specific criteria:
    • ≥1 mm in all leads except V2-V3
    • V2-V3:
      • Men ≥40: ≥2 mm
      • Men <40: ≥2.5 mm
      • Women: ≥1.5 mm
100

The preferred cardiac biomarker for diagnosing myocardial infarction.

What is high-sensitivity troponin?

100

Every NSTEMI patient should receive this medication immediately unless contraindicated.

What is aspirin?

100

Preferred reperfusion therapy when available.

What is primary PCI?

100

Medication class proven to reduce mortality after MI.

What are:

  • Beta blockers
  • ACE inhibitors/ARBs
  • High-intensity statins
200

Horizontal ST depression in V1-V3 with tall R waves suggests this STEMI equivalent.

What is a posterior MI?

Teaching Pearl

  • Obtain posterior leads (V7-V9)
  • Treat exactly like STEMI.
200

Troponin peaks at what time after MI and can stay elevated for how long? Looking for 2 answers 

What is peaks at 12 hours, can remain elevated for up to 10-14 days
200

Name two P2Y12 inhibitors recommended for NSTEMI.

What are:

  • Ticagrelor
  • Clopidogrel
200

Goal first medical contact-to-device time.

What is ≤90 minutes?

(Board pearl: Door-to-balloon ≤90 min.)

200

This medication should generally be avoided in right ventricular infarction.

What are nitrates?

300

This ECG finding should prompt right-sided ECG leads and avoidance of nitrates.

What is inferior STEMI with suspected right ventricular infarction?

Teaching Pearl

  • ST elevation in II, III, aVF
  • ST elevation in V4R confirms RV infarct
  • RV infarcts are preload dependent.
300

This type of MI results from plaque rupture.

What is Type 1 MI?

300

These anticoagulants are guideline-supported for NSTEMI.

What are:

  • Unfractionated heparin
  • Enoxaparin
  • Fondaparinux (requires additional UFH during PCI)
  • Bivalirudin
300

If PCI cannot be performed rapidly, reperfusion should occur with this treatment.

Question
What is fibrinolysis?

Ideal:
Within 30 minutes of hospital arrival.

300

Duration of dual antiplatelet therapy after ACS in most patients.

What is 12 months?

400

Diffuse ST depression with ST elevation in aVR may indicate this dangerous coronary lesion.

What is left main coronary artery disease or severe multivessel ischemia?

Teaching Pearl
This is not automatically a STEMI equivalent, but requires urgent cardiology evaluation.

400

This type of MI occurs because oxygen demand exceeds supply.

What is Type 2 MI?

Examples:

  • Sepsis
  • Severe anemia
  • Tachyarrhythmia
  • Hypertensive emergency
400

This risk score helps determine whether NSTEMI patients need early invasive angiography.

What is the GRACE score?

(TIMI also acceptable.)

400

Name three absolute contraindications to fibrinolysis.

Examples include:

  • Prior intracranial hemorrhage
  • Intracranial neoplasm
  • Ischemic stroke within 3 months
  • Suspected aortic dissection
  • Active bleeding
400

This mechanical complication usually presents 2–7 days after MI with sudden pulmonary edema and a new murmur.

What is papillary muscle rupture causing acute severe mitral regurgitation?

500

These 3 ECG findings are considered STEMI equivalents despite the absence of classic ST elevation.

What are:

  • Posterior MI
  • De Winter T waves
  • Wellens syndrome (critical LAD)
500

A chronically elevated troponin without rise or fall is most commonly seen in these patients.

Who are patients with:

  • CKD
  • Chronic heart failure
  • Structural heart disease
500

Within how many hours should high-risk NSTEMI patients generally undergo angiography?

What is within 24 hours?

Very high-risk patients:
Immediate (<2 hours).

500

After successful fibrinolysis, angiography should generally occur within this timeframe.

What is 2–24 hours?

500

Name three life-threatening mechanical complications after MI.

What are:

  • Ventricular septal rupture
  • Papillary muscle rupture
  • Free wall rupture with tamponade
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