Add: new NSTEMI management question for cardiology

questions/cardiology/acute/acuteCoronarySyndrome.md

@@ -0,0 +1,79 @@
+---
+id: CARD012
+specialty: cardiology
+topic: acute_coronary_syndrome
+difficulty: medium
+tags: [cardiovascular, acs, emergencies, claude35Sonnet]
+created: 2025-01-10
+lastUpdated: 2025-01-10
+---
+
+# NSTEMI Management
+
+## Question
+A 58-year-old man presents with 3 hours of substernal chest pain. He has hypertension and hyperlipidemia. Current status:
+
+Vital Signs:
+- BP: 165/95 mmHg
+- HR: 92/min
+- RR: 18/min
+- SpO2: 96% on room air
+- Temperature: 36.9°C (98.4°F)
+
+Labs:
+- Initial troponin I: 0.45 ng/mL (normal <0.04)
+- Repeat troponin I (3h): 1.2 ng/mL
+- Creatinine: 1.1 mg/dL
+- Hemoglobin: 14.2 g/dL
+
+ECG shows T-wave inversions in V3-V6 and normal sinus rhythm.
+
+Which immediate management strategy is most appropriate?
+
+## Options
+| Option | Description |
+|--------|-------------|
+| A)     | Urgent cardiac catheterization |
+| B)     | IV thrombolytics |
+| C)     | ASA, heparin, beta-blocker; schedule early invasive strategy |
+| D)     | ASA, clopidogrel; schedule stress test in 24h |
+| E)     | Conservative management with oral anti-anginals |
+
+<details>
+<summary>View Answer</summary>
+
+## Correct Answer
+C
+
+## Explanation
+This case represents a NSTEMI with intermediate risk features:
+
+1. Key Diagnostic Findings:
+   - Rising troponins
+   - Dynamic ECG changes
+   - Typical chest pain
+   - Multiple risk factors
+
+2. Why Option C is optimal:
+   - Follows current guidelines for NSTEMI
+   - Provides appropriate anticoagulation
+   - Controls symptoms and reduces ischemia
+   - Plans for appropriate timing of intervention
+
+3. Why other options fail:
+   - A) No high-risk features requiring immediate cath
+   - B) Thrombolytics contraindicated in NSTEMI
+   - D) Insufficient for positive biomarkers
+   - E) Too conservative for NSTEMI
+
+4. Critical Management Points:
+   - Early risk stratification
+   - Dual antiplatelet therapy
+   - Anticoagulation
+   - Anti-ischemic therapy
+
+## References
+- ACC/AHA 2021: "NSTEMI Management Guidelines"
+- ESC 2020: "Acute Coronary Syndromes Guidelines"
+- JACC 2022: "Early Invasive Strategy in ACS"
+</details>