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Finally, do a coronaryangiogram Possible alternative to pacing is to give a beta-1 agonist to increase heart rate. Even with tachycardia and a paced QRS duration of ~0.16 Use Lidocaine instead (lidocaine prevents the PVCs which cause R on T, and does not prolong the QT.) Dobutamine is an acceptable alternative.
One big chunk of ACS-UA is secondary UA where there is increased demand as in stable angina with tachycardia*. we can witness menacingly deep resting ST depression with absolutely no thrombotic process going on in the coronary. Mind you, even a coronaryangiogram will not bail you out in terms of decision-making and risk prediction.
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