spectrum comparison
ACS Spectrum: Stable Angina → Unstable Angina → NSTEMI → STEMI — Escalating Emergency
Chest pain on the NCLEX isn't one-size-fits-all. Choosing "give nitroglycerin and reassess" for a STEMI wastes the 90-minute PCI window. Choosing emergent cath lab for stable angina is equally wrong. Each point on the ACS spectrum has a different urgency, different ECG, and different intervention.
Comparison
Progression4 stages
Progression — 4 stages
Stable Angina
What's happening- Reversible ischemia; no necrosis
Key findings- ★Relieved by NTG in 3–5 min
- Predictable exertional pain; ECG normal/ST↓
Labs / values- Troponin negative
Nursing focus- Teach activity modification + NTG use
- Teach when to call 911
Unstable Angina
What's happening- Ischemia at rest; no necrosis yet
Key findings- ★New, worsening, or at-rest pain
- ST depression / T-inversion; no ST elevation
Labs / values- Troponin negative
Nursing focus- Serial troponins q3–6h; continuous telemetry
- Anticoagulation per protocol
NSTEMI
What's happening- Subendocardial (partial) infarction
Key findings- Prolonged rest pain > 20 min
- ST depression / T-inversion; no ST elevation
Labs / values- Troponin elevated (positive)
Nursing focus- Antiplatelet + anticoagulant; early cath 24–72 hr
- Watch for extension to STEMI
STEMI
What's happening- Full-thickness transmural infarction
Key findings- ★ST elevation ≥ 1 mm in 2+ leads (or new LBBB)
- Severe crushing pain, unrelieved
Labs / values- Troponin elevated (positive)
Nursing focus- Activate cath lab; PCI < 90 min
- ASA, heparin, DAPT; fibrinolytics if PCI > 120 min
★ marks the fact that sets a column apart.
Clinical Pearl
No troponin rise = angina. Troponin up, no ST elevation = NSTEMI. ST elevation = STEMI — cath lab now.
⚡ Speed Sort This Table
Swipe to sort 69 clinical items into the right bucket