A 55-year-old diabetic woman presents with 2 hours of jaw pain and nausea but no chest pain. Troponin I at 4 hours is 2.8 ng/mL (URL 0.04). ECG shows no ST changes. Based on current ESC 0h/1h hs-cTnI algorithm, this presentation is classified as:
- A Unstable angina
- B NSTEMI ✓
- C Stable angina
- D Takotsubo cardiomyopathy
Correct answer: B. NSTEMI
Explanation
NSTEMI is defined by acute myocardial ischaemia with rise and/or fall of cardiac troponin with at least one value above the 99th percentile URL, without ST elevation on ECG. This patient has a troponin of 70 times the URL with ischaemic symptoms (jaw pain, nausea), fulfilling NSTEMI criteria. Diabetic patients frequently present with atypical symptoms (silent or equivalent). Unstable angina has normal troponins. Takotsubo would show apical ballooning on echo and typically follows emotional stress with characteristic ECG findings.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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