A patient is admitted with ACS and unstable angina. To assess myocardial ischemia, which test should the nurse anticipate?

• A. Stress echo
• B. Coronary angiography
• C. In-hospital treadmill test
• D. Cardiac MRI at rest

Answer: (D)

In this acute setting, the priority is to define the coronary anatomy and identify any culprit lesion to guide urgent treatment. Coronary angiography directly visualizes the coronary vessels, revealing occlusions or significant narrowing and allowing immediate revascularization decisions (such as PCI or CABG) if needed.

Cardiac MRI at rest cannot detect ongoing ischemia; it’s more about tissue characterization—scar, edema, and viability—and isn’t used to assess dynamic ischemia in the acute phase. Noninvasive stress tests like a treadmill or stress echo are contraindicated during unstable angina/acute coronary syndrome because exertion or induced ischemia can worsen symptoms and hemodynamics. Therefore, the nurse would anticipate coronary angiography to assess myocardial ischemia in this scenario.