A 62-year-old male with a history of hypertension and diabetes presents with discomfort in his left arm, jaw pain, and generalized weakness for the past 2 hours. He denies typical 'chest pain.' His ECG shows ST depression in leads V4-V6 and T-wave inversions in leads I and aVL. His vital signs are stable. What is the most likely diagnosis?
- AAortic Dissection
- BStable Angina
- CPericarditis
- DNon-ST-Elevation Myocardial Infarction (NSTEMI)
Show answer & explanationAnswer & explanation
Correct answer: D. Non-ST-Elevation Myocardial Infarction (NSTEMI)
The patient's presentation with atypical symptoms (arm/jaw pain, weakness), ST depression, and T-wave inversions are highly suggestive of an acute coronary syndrome, specifically a Non-ST-Elevation Myocardial Infarction (NSTEMI). Stable angina would typically be exertional and relieved by rest/nitroglycerin. Pericarditis often has diffuse ST elevation and pleuritic chest pain. Aortic dissection presents with severe tearing pain and often a pulse differential.
Why the other options are wrong
- A. Aortic dissection presents with sudden, severe tearing chest/back pain and often a significant blood pressure differential between limbs, not seen here.
- B. Stable angina is typically exertional chest discomfort, relieved by rest, and not associated with ECG changes like ST depression/T-wave inversion at rest.
- C. Pericarditis typically presents with sharp, pleuritic chest pain, often relieved by leaning forward, and diffuse ST elevation.
NSTEMI Diagnosis
Non-ST-Elevation Myocardial Infarction (NSTEMI) is a type of acute coronary syndrome where there is myocardial necrosis (elevated cardiac biomarkers) without ST-segment elevation on the ECG. ECG changes often include ST depression or T-wave inversion.
- Symptoms can be typical (chest pain) or atypical (jaw pain, arm pain, weakness, dyspnea).
- ECG findings: ST depression, T-wave inversion, or non-specific changes.
- Cardiac biomarkers (troponins) are elevated.
- Management involves antiplatelets, anticoagulants, and risk stratification.
Memory trick: ECG dips, Troponin lifts, Atypical NSTEMI shifts!