Cardiology
NSTEMI / Unstable Angina
Risk stratification and management of non-ST-elevation myocardial infarction using GRACE score, dual antiplatelet therapy, and invasive strategy timing.
Source: ESC 2020 NSTEMI Guidelines; NICE NG185
Used in: Acute Coronary Syndrome & Chest Pain
Step 1 of ~8
action
Initial Management
Immediate actions:
• 12-lead ECG (within 10 min) — ST depression, T-wave inversion, new LBBB
• Vital signs, IV access, cardiac monitoring
• hs-Troponin at 0h and 3h (ESC 0h/1h algorithm if available)
• Aspirin 300 mg PO loading stat (unless taken today)
• Morphine 2–4 mg IV if pain not controlled by sublingual nitrates (GTN 400 mcg SL × 3, 5 min apart)
• Oxygen only if SpO₂ <94%
• NPO if early angiography planned
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
Drugs
- Insulin (IV Infusion — ICU Glucose Control) · Insulin — ICU Glucose Management
- Sodium Chloride 3% (Hypertonic Saline) · Hypertonic Electrolyte Solution — ICP/Hyponatraemia Management
- Ticagrelor · Antiplatelet
- Prasugrel · Antiplatelet
- Bosentan · Dual Endothelin Receptor Antagonist (ERA)
- Isosorbide Mononitrate (Stable Angina) · Nitrate / Stable Angina
Pathways
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
- Syncope Assessment · ESC 2018 Syncope Guidelines; NICE NG109
Featured in these MRCEM clinical pathways
A deeper exam-focused version of this pathway is available on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only. Always apply local guidelines and clinical judgement.