NSTEMI is a type of heart attack. NSTEMI stands for Non-ST-elevation myocardial infarction. Sometimes an NSTEMI is known as a non-STEMI. A myocardial infarction is the medical term for a heart attack. ST refers to the ST segment, which is part of the EKG heart tracing used to diagnose a heart attack.
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How is a NSTEMI diagnosed?
In addition to signs such as chest pain, a heart attack is diagnosed mainly through 2 ways. Firstly is a blood test that shows elevated levels of certain markers of heart damage such as cardiac troponin. Secondly is by looking at the EKG heart tracing. If there is a pattern known as ST-elevation on the EKG, this is called a STEMI, short for ST elevation myocardial infarction. If there is elevation of the blood markers suggesting heart damage, but no ST elevation seen on the EKG tracing, this is known as a NSTEMI. NSTEMI may be associated with other EKG changes such as ST segment depression. Often looking at the EKG helps us to locate the area of the heart that is affected.
Treatment of Non ST Segment Myocardial Infarction
Once NSTEMI has been suggested, a cardiologist who can help determine the risk and the treatment strategy will typically see a patient. An echocardiogram may be ordered to look at the heart functioning. Initially, blood-thinning agents will be given such as aspirin and the blood thinner heparin. These medicines have been proven to improve outcomes in patients with NSTEMI. There may be other medicines given such as a beta-blocker or nitrates.
Many patients will then go for a test known as an angiogram also known as a heart cath. This test involves injecting dye into the heart arteries to look for blockages. In the case of severe blockages such as a widowmaker treatment in the form of a stent may be required. Sometimes there are so many blockages that bypass surgery is advised.
Prognosis – Life After an NSTEMI
A NSTEMI is a heart attack, so the treatment of that applies. Medicines are prescribed that have been proven to save lives in the long term for heart attack sufferers. Depending on factors such as symptoms and heart function, a number of medicines may be prescribed. Lifestyle changes and modification of risk factors is key in preventing recurrence. It is important for smokers to stop smoking. Blood pressure control and control of diabetes are key. A post-heart attack exercise plan should be incorporated into a daily lifestyle if possible. Often NSTEMI patients will be sent to cardiac rehab to receive education on the important of exercise and begin a program in a supervised environment.
Why Does My Hospital Discharge Paperwork Say NSTEMI But No-one Told Me About a Heart Attack?
Part of the way of diagnosing a NSTEMI is by a blood test called troponin that is indicative of heart damage. Although the troponin test is great in that it does not miss heart attacks, it is not specific for heart attacks alone. Basically, there are other problems that can cause an elevated troponin level. Many patients with critical illnesses, infections and kidney disease among many other conditions can have an elevated troponin that is not related to heart blockage. In these cases, although sometimes it is labeled NSTEMI, there is no concern for underlying critical heart blockage.
Common Medicines Prescribed After a Non ST-Segment Myocardial Infarction
An antiplatelet agent that helps to thin the blood and reduce rates of further heart attacks
Plavix (Clopidogrel) or Effient (Prasugrel) or Brilinta (Ticagrelor)
These antiplatelet agents thin the blood preventing further heart attacks. These are often given for a year after heart attacks and sometimes longer. When a stent is placed, it is important to ensure these medicines are not stopped until advised by a doctor as they help prevent clotting inside the stent.
These agents slow the heart rate down and reduce the amount of work the heart has to do.
These medicines can help reduce enlargement of the heart, and control blood pressure and are proven to be beneficial with regard to outcomes after a heart attack. When there is heart muscle dysfunction, these medicines may strengthen the heart and prevent further deterioration.
Statin (Lipitor/Crestor (Atorvastatin, Simvastatin, Rosuvastatin, Pravastatin))
These cholesterol medications are proven to help prevent recurrent events in heart attack patients and are currently recommended as a lifelong treatment in those who tolerate them. In addition to lowering cholesterol to hopefully meet published guidlines, they help to stabilize the vulnerable plaques that are responsible for heart attacks. Read this article to answer, “Should I Take a Statin?”
Other Medications / Treatments
A variety of blood pressure medications may be used to control high blood pressure, a risk factor after a heart attack. If there is heart muscle dysfunction and heart failure, a drug called Spironolactone (Aldactone) may be added to help prevent further deterioration and to strengthen the muscle. If there is persistent chest pain after the attack and initial treatment drugs called Nitrates (Imdur) may be added to provide relief.
STEMI vs NSTEMI – Which is Worse?
The bottom line is that both are just as bad. STEMI is seen as more of an immediate emergency because there is a known total occlusion of a heart vessel that needs opening back up urgently. In terms of long-term outcomes, they have equal health implications. Patients with NSTEMI often have other illnesses such as ongoing critical illness, diabetes, kidney disease, and other that means they have a generally high risk over the long term. Both STEMI and NSTEMI need aggressive treatment over the short and long term.
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