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

Stable Angina
What's happening
- Exertional (demand) ischemia
- No myocardial necrosis
Key findings
- ★Relieved by NTG in 3–5 min
- Predictable exertional pain
- ECG normal at rest
- no ST elevation
Labs / values
- Troponin negative
Nursing focus
- Managed as an outpatient
- Teach SL NTG use + when to call 911
→
Unstable Angina
What's happening
- Ischemia at rest
- No myocardial necrosis
Key findings
- ★New, worsening, or at-rest pain
- ST depression / T-inversion
- no ST elevation
Labs / values
- Troponin negative
Nursing focus
- Serial troponins to rule out MI
- early cath 24–72 hr
- Antiplatelet + anticoagulant
- Teach SL NTG use + when to call 911
→
NSTEMI
What's happening
- Subendocardial (partial) infarction
Key findings
- Pain > 20 min, unrelieved by NTG
- 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
- Teach SL NTG use + when to call 911
→
STEMI
What's happening
- Full-thickness transmural infarction
Key findings
- ★ST elevation in 2+ contiguous leads
- Pain > 20 min, unrelieved by NTG
Labs / values
- Troponin elevated (positive)
Nursing focus
- Activate cath lab
- PCI < 90 min
- Antiplatelet + anticoagulant
- fibrinolytics if PCI > 120 min
- Teach SL NTG use + when to call 911