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.
At myheart.net we’ve helped millions of people through our articles and answers. Now our authors are keeping readers up to date with cutting edge heart disease information through twitter. Follow Dr Ahmed on Twitter @MustafaAhmedMD
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
Aspirin
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.
Beta-Blockers (Metoprolol/Atenolol/Carvedilol)
These agents slow the heart rate down and reduce the amount of work the heart has to do.
ACE-Inhibitors (Enalapril/Lisinopril/Ramipril)
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.
Have you or a loved one had a NSTEMI? Click here to read about cutting edge and potentially life saving treatments written by myheart.net author and cardiologist Dr. Alain Bouchard
Comments are purely for informational purposes and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Disclaimer
Thank you so much for taking the time to write these articles.
Found this article VERY informative. Myself, having a NSTEMI at 48. LAD was 99% blocked that was able to be stented and the RCA is still totally occluded. This has resulted in 4 additional cardiac caths to attempt to open the RCA, but with no success. Non exertional angina has led me to be placed on Imdur and Ranexa, among the other meds that were given to me at discharge. My fear, is that with this blocked RCA, I can just keel over at any given time and that’s it for me? Is it possible to lead a normal life, within reason, like working as a truck driver, with this CTO?
In general I would say that a CTO, in the setting of a stable condition is not necessarily life threatening, and when we treat them it is for quality of life rather than any other purpose. Medical therapy is most important, and if this doesn’t work then an attempt at opening the CTO is warranted. Im surprised its taken 4 attempts to open the artery. I suggest you go to a dedicated CTO center. In such centers we generally have the tools and techniques to make the majority of attempts successful. Once again, its not the blocked RCA that is the indication to stent, it would be persistent symptoms despite optimal medication. If you have no symptoms at all then medication may be preferred.
Given the large amount of people we have been able to help here at my heart.net, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at MustafaAhmedMD
Hello
Is morphin sulfat contrainddicated in NSTEMI ? And why ?
It is often used as treatment for the acute period to treat pain.
My husband is 47 he had 3 heart attack his diagnosis is 3 vessel CAA WO NSTEMI dislipidemi Htn , where his cholesterol is very high and the doctor is recommending him to do CABG. Does this is the only options for him to unclogged his arteries? What is the best thing for him at this stage he is on medications now.
Of course i would have to see the images to comment specifically. In most cases of NSTEMI with triple vessel disease bypass surgery would be advised particularly if there is dysfunction of the heart or diabetes.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
I’m a 59 year old female – thought I was the picture of health. Thin, exercise, good nutrition. I landed in the hospital with a “vasospasm with resulting nstemi”. My test results were all normal – EKGs normal, angiogram normal, echocardiogram normal. The cardiologists believe this was brought on by Sumitriptan (Imitrex). Obviously I will stop taking that! They told me several times I did NOT have a heart attack, but it seems from what I’ve read, I did. I’m confused as to whether my diagnosis is the same as broken heart syndrome or something different. My troponin levels were elevated. The incident didn’t happen during any exercise – I was actually lying down looking at my iPhone. I called 911 due to severe jaw and left arm pain. How likely is this to happen again, if I stop the Imitrex? They told me my heart was in great shape and that there was no damage. Thanks in advance for any opinions or help.
agree with stopping the imitrex, however how was the diagnosis of spasm made, did you have any st elevation at any time on the EKG?
you can follow my twitter at @MustafaAhmedMD
Hi sir my father age is 58 and his troponin t report was 11mg/L reference is 24 mg/L what does it mean??
58 year old male. I’ve had a stent placed LAD at 90% blockage, the stent was then blocked at 99% about 11 months later (NSTEMI). So they stented the stent (with a drug-eluting stent like the first one). That was 3 years ago. Initially I was told I would be on a regimen of Effient (Prasugrel) and aspirin for the rest of my life (that was back in 2014). Now, I am hearing that there is evidence that the Effient medication has little practical benefit after about 6 months to 1 year, post stent placement. Some seem to suggest a Plavix/aspirin regimen after ceasing the Effient, and that the Effient is one of the more stronger medications that maybe shouldn’t be used long-term. Have you heard of this new evidence?
My 90 yr old father had diagnosis of NSTEMI. We did not choose angiogram test due to age and frail health, instead chose medication treatment alone. Plavix and Metroprolol added to his standard med list of Xarelto and Atorvastatin and removal of baby aspirin. He has low blood pressure to begin with 100-120 on average over 79-80. Is he in danger of extremely low blood pressure problems or any other side effects of concern? Thank you
The medical approach in this setting with careful consideration appears entirely reasonable. The meds are known to help. With regards to BP, the metoprolol in general has a fairly weak bp effect and so hopefully will not lead to issues. In general i have all my patients use home bp monitors, measure at least twice a day and keep a diary that can be taken at time of follow up visit and be critical in making treatment adjustments.
you can follow my twitter at @MustafaAhmedMD
March 5th I went to E.r because i was having pain in my elbows and arms and chest. Was hurting to swallow. I got to hospital at 11am and they took my Bp it was 160/119 and gave me ekg. They had me sit in waiting room until 1:15pm when i had my blood drawn and my troponin level was 0.53 ng. By 7pm my troponin level was 5.510ng and i got moved to the cath lab and had an echocardiogram and then had a heart cath done. To find out my Ef was 30% and i had a blockage in the middle of something they called the widowmaker. They put a stent in and said my Ef didn’t improve and kept me in hospital for 5 days and said i had to wear a Lifevest. I’m a 39 year old female that has been dealing with seizures for 2 years and trying to figure out where those are coming from and now i have this. Ive been put on brilinta,coreg,lisinprol and aspirin,lipitor. That’s on top of my Aptiom and Topomax i take.