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.

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Comparison

Progression4 stages
Progression — 4 stages

  1. 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

  2. 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

  3. 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

  4. 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.

Component Topics

Myocardial Infarction — STEMI vs NSTEMIStable Angina vs Unstable Angina

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