Have you or a loved one recently suffered from a STEMI (ST-elevation myocardial infarction) heart attack? Are you a physician or med student looking for STEMI diagnostic and treatment guidelines? This article is an all-encompassing STEMI resource guide.
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
Patient’s Guide to STEMI
What is a STEMI Heart Attack?
A STEMI is a full-blown heart attack caused by the complete blockage of a heart artery. A STEMI heart attack, like a Widow Maker, is taken very seriously and is a medical emergency that needs immediate attention. For this reason its often called a “CODE STEMI” or a “STEMI alert.” STEMI stands for ST elevation myocardial infarction. “ST elevation” refers to a particular pattern on an EKG heart tracing and “myocardial infarction” is the medical term for a heart attack. So STEMI is basically a heart attack with a particular EKG heart-tracing pattern.
Definition
When someone is being evaluated for chest pain the EKG tracing is done as soon as possible to help see if it’s the heart. An ST-elevation myocardial infarction (STEMI) is a combination of symptoms of chest pain and a specific STEMI EKG heart tracing. The EKG has to meet what is called STEMI criteria to make a correct diagnosis, just like an NSTEMI will provide another set of specific diagnostic criteria. The EKG also provides information as to which part of the heart the blocked artery is supplying, for example an anterior vs. a posterior STEMI vs. an inferior STEMI. An anterior STEMI is the front wall of the heart, and the most serious. A posterior STEMI is the back wall of the heart. An inferior STEMI is the bottom wall of the heart.
What Happens to the Heart?
In a heart attack there is sudden rupture of an unstable part of the wall in a heart artery. This leads to a build up of clot in an attempt to heal it however this clot formation results in total blockage of the artery. Unfortunately this total blockage leads to loss of blood supply to the heart beyond that point. The heart muscle stops working within minutes of this and dies within minutes to hours unless the artery can be opened back up. For this reason every minute from the onset of a heart attack is absolutely critical. Often the patient doesn’t make it to hospital due to sudden death. For those that leave it too long or for those in whom the heart attack isn’t treated, the heart muscle dies and is replaced by a non beating scar.
Treatment
The most important part of any STEMI treatment protocol is to get to the hospital as quick as possible, so basically to call 911! In a STEMI an artery is blocked and treatment centers on opening this up as quick as possible. The preferred way to do this is by performing something known as angioplasty and stent placement. In this procedure the artery is opened back up working through a small tube passed to the heart either from the wrist or the groin. In some cases this cannot be performed fast enough and to avoid a delay in treatment clot busting drugs are used. Unfortunately these are not as good as they are less likely to open the artery back up and are also associated with bleeding complications. They are better than no treatment at all though so sometimes we have to use them.
In addition to this a number of other treatments are used. Painkillers such as morphine are used to settle pain and reduce the anxiety. Oxygen is administered to those who are breathless or have heart failure. EKG monitors are attached so that potentially lethal arrhythmias such as ventricular fibrillation or even less dangerous but still significant arrhythmias such as inappropriate sinus tachycardia or AFIB with RVR can be identified and treated. Blood thinners such as heparin, aspirin and other platelet inhibitors (clopidogrel/ticagrelor) are used to improve outcomes and prevent more heart attacks.
Post-STEMI Recovery
Educating patients and their families is one of the most critical aspects of care after a STEMI. Several new medicines are started after a heart attack, several of which may be needed lifelong. Patients need to be sure they take the medications prescribed to have a benefit. Stopping smoking is essential. It’s important patients follow up with their doctors. Drugs should be used to control blood pressure such as amlodipine if uncontrolled. After a STEMI patients will be enrolled in cardiac rehabilitation that is a program they attend on a regular basis. This involves exercise, addressing questions such as time of return to physical activities and dietary concerns. Following these things after the STEMI is arguably as important as treating the STEMI itself.
STEMI Guidelines for Healthcare Professionals
This section provides STEMI management guidelines for doctors and physicians that are compliant with AHA & ACC STEMI heart attack guidelines.
Identifying a STEMI with an EKG
Definition
The STEMI definition varies by sex and age.
For men ≥ 40 years old – 2mm in V2-V3 and 1mm in all other leads.
For men ≤ 40 years old – 2.5mm in V2-V3 and 1mm in all other leads.
For women – 1.5mm in V2-V3 and 1mm in all other leads.
Localization
A STEMI can be localized by identification of ST elevation in the following.
STEMI type EKG changes Likely Artery
Anterior STEMI – V3 V4 LAD
Inferior STEMI – II III AVF RCA >> Lcx
Posterior STEMI – STdepression V1 V2 V4 V4 RCA >> Lcx
Lateral STEMI – I AVL V5 V6 Lcx
Anterolateral STEMI – I AVL V3 V4 V5 V6 LAD / Lcx
Septal STEMI – V1 V2 LAD
Anteroseptal STEMI – V1 V2 V3 V4 LAD
LBBB and STEMI EKG
The baseline EKG in LBBB makes diagnosis of STEMI more challenging. Although not perfect, the Sgarbossa criteria are often applied. The points as seen below are added together and a total score of ≥ 3 has 90% specificity for diagnosing LBBB and STEMI.
- Concordant (Upward) ST elevation > 1mm in leads with a positive QRS complex (a score of 5)
- Concordant ST depression > 1 mm in V1-V3 (a score of 3)
- Excessively discordant ST elevation > 5 mm in leads with a negative QRS complex (a score of 2).
Risk Factors for ST-Elevation Myocardial Infarctions
Some scores have been developed to work out a STEMI patient’s risk of poor outcomes. These scores incorporate many factors that include the following:
- Older age
- Worsening heart failure
- Time taken to treat the STEMI
- Cardiac Arrest
- Earlobe Crease
- Fast heart rate
- Low blood pressure
- Diabetes
- Smoking
- Kidney disease
We can use these scores to determine risk and how aggressive we should be in treating patients presenting with STEMI.
TIMI Score http://www.mdcalc.com/timi-risk-score-for-stemi
Grace Score http://www.outcomes-umassmed.org/grace/acs_risk/acs_risk_content.html
STEMI Protocol for Treatment
STEMI patients who present within 12 hours of symptom onset should receive treatment to try and open up the blockage known as reperfusion. This can either be by clot busting drugs given through the veins or by a procedure known as balloon angioplasty and stent placement (PCI). PCI is by far the preferred option as long as it can be done in time.
- If there is a possibility of PCI starting within 120 minutes (within 90 preferred, the faster the better) then this is preferred
- If there isn’t the possibility of being taken to a PCI center and the procedure started by 120 minutes then clot busting drugs should be given
- If its decided that clot busting drugs be used, then these should be given within 30 minutes
STEMI and Cardiac Arrest
- Patients with cardiac arrest caused by lethal heart rhythms should have initiation of a cooling hypothermia protocol
- Patients with cardiac arrest surviving to hospital and STEMI initially should have PCI
STEMI and Angiography after Lytics
- Those who got lytics but are in in shock, HF, or high-risk findings on testing should have angiography
- In those even with successful reperfusion therapy its reasonable to perform angiography prior to discharge, although not within 2-3 hours of lytic therapy
Medications After ST-Elevation Myocardial Infarction
Aspirin
Aspirin should be given for STEMI and continued life long
P2Y12receptor Inhibitor
This includes Ticagrelor, Plavix and Prasugrel; this should be given early or at time of stent placement in STEMI. Should be given for a year if stent is placed.
Heparin After Lytics
Heparin should be given for at least 48 hours after lytic therapy and continued for the hospitalization or until PCI performed.
Beta Blockers
Beta-blockers should be given after STEMI in those patients without contraindications
ACE-inhibitors
It’s reasonable to use ACE inhibitors in all patients after STEMI without contraindications
Please share your experience in the comments for others to learn from.
I am 64. Had STEMI on Òct. 7,2014. Thank you for your article on STEMI. I have gained
more info than my doctor ever gave me.
I also had to go to the hospital I had a stmi heart attack on thanks giving morning was in the hospital for 21 days
.
Stemi
I also had a stemi heart attack thanks giving morning of this year and was in saint Francis hospital in Greenville South Carolina for 21 days
I also had a stemi heart attack November 28th of last year
I also had a full blown heart attack in 2013 at the age of 68. This article was really interesting ,and, yes, I also received more information that my doctor has given me. Now, the new procedure at his office is not to discuss very much, if anything, with his patients but to hand them a bunch of paperwork on their way out. This was done with me 2 weeks ago. He discussed NOTHING with me at all, was too busy fiddling with the damn computer,and I looked at this paperwork when i got home and found I have acute ST elevation myocardial infarction (STEMI), LV dysfunction,Essential hypertension,Hyperlipidemia,coronary artery disease involving native coronary artery of native heart without angina pectoris.
Thank you ,Dr, for explaining this to me. My next question is, why do i have to see you?
You are not a god, you do not walk on water,and your patients are not groveling peasants accepting a crumb now and then. You get paid royally,and we deserve some answers! I hope a lot of doctors are reading this!
Hi Faith,
Im sorry you had such a bad experience both in terms of your heart condition and in terms of your follow up. Its important to discuss matters at length with patients and that is actually the driving force behind the information available through this site. I would hope that for every experience you described, there are ten-fold good experiences whereby patients feel their condition has been explained in depth and also feel their doctor genuinely cares, as i am convinced that in the overwhelming majority of cases they are. As a Dr, i can tell you that i feel fortunate to be in my profession and have the opportunity to help people and hopefully your next experience is better. With regards to following up with a doctor, even if it is someone different i encourage you to do so as the care after a heart attack is arguably as, if not more important than the care during.
Faith, I feel the same way. I call my doctor a man of few words. All the knowledge I have received has been thru books and the internet. But I will be seeing him in December, and will thank him for saving my life, but no live lost, I’m moving on. That’s right, new doctor here I come.
I am extremely lucky and fortunate. In September 2017, I suffered an Anterior Stemi having been rushed to hospital for angiogram, angioplasty and insertion of a Stent. My lady Cardiologist was brilliant, explained what happened and the procedure to resolve the problem during the procedars. I am now home, exercising, modifying my diet and lifestyle and start rehab in two days. There is no doubt I was near the pearly gates. I give grateful thanks to my Cardiologist, the support team, emergency operator, Paramedics and many other people who gave me my life back. When I thanked the Cardiologist for saving my life, modestly, she replied “It’seems what we do”. I live in England and we have the wonderful NHS service.
Dear Dr Ahmed,
My father has recently experienced a heart attack. What is written on the board in hospital is “Ant STEMI”.
I read the article and found out it is the most serious one. He is 58 years old.
What should we do? Does ANT STEMI mean a near death? How it will affect my dear father’s quality of life?
I am so upset and can’t stop crying…
Hi, do you have information on his heart function and the amount of damage sustained. Also what treatment was given?
Hello Dear Dr Ahmed,
Thank you for answering my question.
The Doctor visited my father in the hospital and We haven’t yet been able to visit his doctor to talk about damages or any other thing! He was in hospital for 4 day, 2 days in CCU and 2 days in post-CCU.
Also, I could not find any useful information on papers which described his situation. Just they mentioned diagnosis as “Ant STEMI”.
A stent has been put inside his heart and a lot of medicines have been prescribed. He is told to visit the doctor next month.
We have even no idea how to take care of him. He wants to go back to his heavy work very soon.
It seems that his doctor is too busy to see and talk to him. Do you advise us to visit another doctor to tell us more details about his condition?
It is a very hard situation…
I think you mean NSTEMI, which is a non-ST Elevated Myocardial Infarction.
Hi my name is Ben i had a stemi heart attack at the age off 36. I had 2 the first i thought was just indigestion then the second one was a lot worse. My wife is a nurse a thankfully came home to find me mid attack and called an ambulance. Recently i have started smoking again and have been getting chest pains. Should i get a blood test done to check my stent is ok. As well as stop smoking i know
You need to be assessed for the pain and likely need some form of stress testing.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
I had mine on tuesday. I am 36 as well.
I had a STEMI in November 2015. Spent 9 days in the hospital and had 2 stents placed in my heart. My question is #1. Will I ever get back to normal. I haven’t had the energy or strength that I had before the STEMI. #2. How do I know how much damage was done to my heart. I actually coded and was dead for 5 mins. Before they got me back.
I can’t thank you enough for this article. My husband survived a STEMI heart attack at the age of 44. He was at his healthiest weight and very active. Non smoker. His family has a history of heart disease. He did not have heart disease. It has been two years since the heart attack and we will never be the same. This article is very informative and accurate as to my husbands experience. Sincerely, The McLaughlin Family
My husband, who is 48, had a STEMI in early May. He also, has kidney damage. Which was present before the heart attack. The cardiologist on call in the ER chose to not do a stint due to kidney risk. Now his kidney functions are much worse. We received very little information and little to no help for at home. He was sent back to work at a very strenuous job and struggles daily just to survive.
My husband had a STEMI heart attached in February, it started at 6.15 the paramedics arrived quite quickly, but the we were told there were no ambulances and so had to wait 2 hours for one to arrive, hence it is a miracle my husband is still alive. He is 58 he has now been told he has very serious scaring of his heart and the echo that was recently done showed that he has an infraction rate of just 25%. We are devastated, he was not overweight a life long non smoker and this happened and to top it all we were really let down by the ambulance service. So sad. Your article is very interesting but it won’t help my husband now.
The ejection fraction will come back with diet and exercise. After my heart attack my Ef was 30-40 %. Staying positive exercise and diet has brought it up to 54%. Just don’t give up.
It does not always return to normal, regardless there are countless benefits to diet , exercise, medicines and so on regarding quality and length of life after a heart attack.
you can follow my twitter at @MustafaAhmedMD
I’ve had a stemi 3 weeks ago and another 2 days ago I’m always tired and sleepy when will I start feeling better
I had mine may 30 2019
Im still tired too but i get through it somehow
Started cardio rehab a couple days ago that will help i hope
Feel free to email me if you want to talk
I am 52 and work in a very stressful job in health care. I recently lost my father and am caretaker for my Mother who is stage four cancer. I just had a inferior Stemi heart attack at work this week. Luckily I was at work when I had the heart attack and was rushed immediately to CTU and had an angioplasty and a stent put in. I have four other blockages that are all at forty percent. What is the likelihood I will have another heart attack?
Likelihood depends on risk factors, the key is to understand how to minimize risk. Compliance with medications, control risk factors such as diet, diabetes, exercise, weight, lifestyle etc, ensure non smoker, control blood pressure. These factors can significantly reduce any likelihood.
Thank you for the informative article. I have been exhaustively researching anything I can find regarding my husbands cardiac care post STEMI. This article is easy to understand in layman’s terms and includes a good graphic of the heart as well. Fortunately I asked a lot of questions and took notes during his week in CCU because I believe being armed with as much information as possible will help him survive this. Now I have a list of questions for his cardiologist at his follow up appointment next week. Getting through this is extremely overwhelming but don’t rush to blame the doctor for lack of information – inform yourself and ask questions! There are many good resources out there. If you are not getting the answers you need or you are not happy with the care you are receiving – go for a second opinion.
This is a very resourceful site and I love the way Dr. Mustafa Ahmed is more that very willing to make us understand more about STEMI and the part and role of caregivers and the next of kins in making the management of the case even much effective. thank all of you for being here we learn together.
Great info. Thanks
I’m 37 and two weeks ago had a inferior st elavated stemi stent fitted.4 years ago I had renal artery stenosis of right renal artery angio performed no stent amlodipine and natrillix until two weeks ago I got diagnosed with fibromuscular dysplasia renal artery four years ago too I’m scsared
Were you diagnosed with SCAD? Many young women who have had a heart attack and have FMD have suffered from a Spontaneous Coronary Artery Dissection (aka SCAD). Alomost two years ago at age 45, I had a STEMI due to dissection and 100% blockage in my LAD, luckily towards the end of the LAD with minimal heart damage. I was very lucky. I heard the word dissection while I was in the hospital which led me to researching the situation and finding that I may have had a SCAD. I found the Mayo Clinic for a second opinion and SCAD Research, Inc. which has been helpful in my recovery and emotional support.
I am a Registered Nurse and this article is very informative along with all the other articles on this website. Thanks for making it available to all of us to read.
What’s the life expectancy after having an anterior STEMI IM 43yrs old and had my heart attack in October just gone, Thank-you for your very informative article.
Hi so last Tuesday I had a stemi (inf) heart attack. One day before my 43rd birthday. Thankfully paramedics reached me in time and got me to hospital within 20 mins, and the stent was in immediate – I spent 3 days in hospital and my recovery has been good so far – but I tend to sleep and doze off every half hour, I also experience dull aches and pains in my upper arm and back and chest (not in great pain) just uncomfortable – is this normal and how long does it last please
I think you certainly need to see a cardiologist to get a direct opinion. Its difficult to say what the pain is without knowing full details of the case. If it persists, you may need some form of post MI stress testing.
I had a inferior stemi on 15 th march this year. I had a stent placed in the rca and one cardiac arrest. I am still getting a dull ache in my chest every day and sometimes a stabbing pain and a dull ache down my left arm.. Could you tell me if this is normal please .. not seem my cardiologist yet ..thank you . By the way I’m 52 ..
Its a good idea to go and get an opinion from your heart dr. Without knowing the full details of the case and seeing the images its difficult to comment. Hopefully its not a significant issue however its likely that clinical examination EKG, and some form of stress testing is advised to ensure thats the case.
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 had a heart attack last year to this day. I had 2 DES placed in my LAD. I am on Plavix and aspirin and would like to stop taking the Plavix. My doc says I may be on it for the rest of my life. What are the numbers associated with people that stop after one year vs the people that take it forever? I just hate taking meds daily.
Thanks
In general, after DES placement 6-12 months of plavix is recommended. Stopping before 6 months isnt generally recommended. If your dr wats you to continue after a year then it may be potentially due to the complexity of the disease and that should be discussed. If standard disease then in general it would be considered safe to stop the plavix particularly after a year however i would check with your dr first.
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
Dear Dr. Ahmed,
Greetings.
Thanks for the nice and very useful articles which go connected with me right away when I read the title.
My name is Umesh Kumar, 34 years Old. When I was 31 years old I suffered LAD 90% blockage (more of coagulation rather than proper blockage) and VF arrest. The symptoms and procedure details (technical) are below.
” I was with acute AWMI-STEMI, S/P VT arrest, PAMI with DES to LAD was done on 21st July 2014.
CAG – Normal
LAD- 90% with large thrombus proximal to S1with 40-50% diffuse more proximal
LCX- Normal
RCA- small dominant, normal.
Procedure: PTCA and stenting of proximal LAD done with 3.5x24mm endeavor resolate DES after 2 runs of thrombus aspiration. Post dilated with 3.75mm NC at 20-ATM, good results.
Firstly I was smoker now I quit on the same day. Doctors used AED immediately when I collapsed and performed above procedure and said no muscle was damaged.
I am on treatment with Aladactone, Cardace Meto or Seloram, Ceruvin A 75/75 and Crestor 20 mg.
I would appreciate if you could answer my below queries.
1. How is my heart attack is different ? was that serious, because whenever any doctor see my report they say that I am very lucky. What could have happened to me if I didnt reach hospital in time ?
2. After reading above comments from others, they say that if LAD is 60% blockage we need to perform By Pass, but in my case it was not done.
3. I quit smoking, exercising and dieting, Does the above disease affect my Longevity, if so how many years more I have?
Whenever I do some research about this I would go into depression or anxiety and the same time I feel lucky and I am. Thanks for the advancement in science.
Thanking you in advance.
Best Regards,
Umesh Kumar,
+91 9886306272.
1. How is my heart attack is different ? was that serious, because whenever any doctor see my report they say that I am very lucky. What could have happened to me if I didnt reach hospital in time ?
Your heart attack is not different from most, it likely started with rupture of a plaque than then resulted in thrombus formation and occlusion. You are very fortunate due to the location of your heart attack. Its a dangerous location in terms of significance and potential size of heart attack however you were fortunate as you didn’t have damage. You could have had a worse outcome, but you didn’t, so i wouldn’t worry.
2. After reading above comments from others, they say that if LAD is 60% blockage we need to perform By Pass, but in my case it was not done.
Bypass was not indicated in this setting. Most LAD blockages that occur in the absence of other lesions can typically be treated with stenting.
3. I quit smoking, exercising and dieting, Does the above disease affect my Longevity, if so how many years more I have?
You are doing a good job, there is no reason you cant reach a normal life expectancy. There is no point in thinking otherwise.
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
Dr. Ahmed,
I’ve been reading your articles since my heart attack back in November 2016. In summary, here is my case: African American male age 51 (at the time), seemingly perfect stats- height 5’10, non-smoker, cholesterol 160, weight 175, blood pressure 110/60, workout 3/4 times a week, eat healthy.
Boom…100% occlusion of the LAD. I went into cardiac arrest in the ER and was defibrillated once and regained consciousness. Thank God I was having dinner with a good friend who just happens to be a cardiothoracic surgeon and knew exactly what was happening. I had a stent placed in the LAD and angioplasty in a branching artery that was 95% occluded. After such a massive heart attack my cardiologist says there is no damage to my heart??? How can that be when the definition of an MI is muscle death??? My Ejection Fraction before leaving the hospital was 72.
Fast forward I’m on aspirin(81mg), Brilinta (90mg), Lipitor (20mg), and Metoprolol (12.5mg)…the later 2 meds were cut in half due to my already low cholesterol and blood pressure.
Thank you in advance and keep up the GREAT work!
When a vessel is occluded there is in general severely reduced blood flow to the supplied area of the heart. This is called ischemia. The heart muscle does not die within the very initial stages, although it is severely impaired. The muscle is typically irreversibly damaged by 2-4 hours, however prior to that it is typically salvageable. If one has a heart attack (occlusion) and it is immediately attended to with restoration of blood flow, there can in theory be no damage. The correct term for the initial phase is myocardial injury and not infarction.
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
@Mac, I recently had a heart attack October 5, 2017. I wasn’t sure if I was having a heart attack that Thursday night or severe heart burn or indigestion. I wanted for 2 days before going to Urgent Care. My blood pressure was low and they said I was having a heart attack. I was rushed to Washington Hospital Center E.R. and a stent was placed in my heart. As a black 62 year old male, I didn’t smoke, drink alcohol, and I tried to eat healthy using no salt cooking my food and watching my sodium intake. My last blood pressure reading at Kaiser earlier the day of the heart attack was 118/68. I did refuse cholesterol medicine 10 years ago by my Primary Care Physician because I read Lipitor can do damage to your liver and other friends that was taking Lipitor had problems with taking the medications. I have a blood clot on my heart and 20% of my heart was damaged. I am taking 7.5 mg of Warfarin, 80 mg of Lipitor, 1 baby aspirin a day until November 7, 2017, 90 mg of Brilinta, 25 mg of Eplerenone, 25 mg of Metoproolol, and 50 mg of Losartan. My cardiologist think my heart will recover with in year continuing the medication. Hopefully I will be off the Warfarin in 6 months. I am glad to still be in the land of the living. I thought cancer was the number 1 killer in America and I was wrong, its heart disease.
Dear Dr Ahmed,
Thank you so much for this easily understood article.
I am reading my husband’s cardiology report after he suffered an anterior STEMI 8 weeks ago, and wanted to check on the terms used. I need to be informed so that I can play my part in his ongoing health situation.
He went back to work 2 weeks ago.So far so good.He has completed cardio rehab,takes his 6 meds ‘religiously’,and walks every day.He had the first symptoms(that were very atypical!!) in the gym-he’s had over 900 visits- 2 sessions a week.He is VERY fit, lean, low blood pressure, no family history, good diet, no diabetes, on low level cholesterol meds for 10 years(‘insurance’-our GP!). What he DOES have is enormous work loads in a managerial position! I am convinced that stress was the main factor in his heart attack.He plans to retire (is already past retirement age- loves his job) within the next 6 months, all being well in the meantime.His work loads have been somewhat reduced, but management don’t really ‘get it’ when it comes to his workload….I am watching this closely!!! His episode shocked so many people, because of his good health, and because the symptoms were not what we expected.
Hi just a quick question. I had a late anterior stemi that caused a large hole in my septum that required immediate patch surgery. I felt no pain just very weak and sickly, like flu. I had no prior heart problems. What causes a septum to split and should I take extra care or precautions considering the lack of pain. Thank you.
The hole in your septum is known as a VSD, ventricular septal defect. You are very fortunate to have survived the incident and glad to see you have done well. the septum splits because the tissue dies since the blood supply to it is cut off, then the dead tissue can become weak and tear. In terms of precautions i would just advise the care as prescribed on your discharge instructions by the treating team.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
Hi Dr. Ahmed,
My 37 year old boyfriend had an MI last year in the LAD. He arrested and was given cpr and was rescusitated without intubation. The clot was removed and he was not given a stent. His cholesterol is around 200 and improving with dietary changes. A year later he is experiencing a lot of left side pain which has never subsided . He currently is taking aspirin and atenolol daily. Most pain is in shoulder, posterior. And below axilla. He was given very little information about damage caused by mi, or cpr for that matter. It’s unknown whether he sustained trauma from the cpr. The pains appear to be muscular in nature, but numbness in fingers has never subsided since the mi, and Pain in the left arm has never subsided. No pain he has correlates with activity, and his bp runs stable at 120-130 systolic. Any info you might have would be helpful.
Given his history he should certainly be evaluated and physical exam performed. Initial work up would likely include a treadmill test and possibly echocardiogram. Although the symptoms may be musculoskeletal, given his history he should be evaluated.
you can follow my twitter at @MustafaAhmedMD
Dear Dr,
I had a stemi at 46 yo had 3 stents (one LAD, and 2 RCA), and I am 51 yo now. I was in good health with good profile for chol and bp, and the STEMI was unexpected. It was later discovered that it was caused by elevated level of Lp(a) (around 90 (normal 38?)), which in the UK is not treated but risk mitigated through chol. medications. I am on medication bisoprolol, perindorpil, rosuvastatin and aspirin – all low dosages. My question is: What is the risk of a second STEMI and do I need to be concerned of my life expectancy as I have a relatively young family that relies on me, and I feel responsible for. many thanks!
I had an Anterior STEMI on 1 January 2018 with moderate atheroma. I found your article when I was trying to interpret what my cardiologist’s letter said. I did not know until the day after that I had had a heart attack. No one explained what was happening at all.
Thats the reason we make this resource available. Hope you found it useful.
you can follow my twitter at @MustafaAhmedMD
I recently had a anterior STEMI and ignored the warnings. I am a Paramedic and can not believe I ignored the signs. Thank God I am alive, I had 95% blockage of the LAD and 40% EF. My husband insisted I went to the doctor, he called and made an appointment. The doctor took an EKG and called 911..I was having a heart attack. The ER crew was waiting for me and sent me to the Cath surgery where I was given a stent. I am 74 yrs old had many risk factors and now have changed my life style. God has given me a second chance and the doctor just looks at me and shakes his head and said you are one lucky woman!! Your information that you provided was very helpful for me to understand the whole scernio of the heart.
Thank you Dr Ahmed,
Like many others, I gained more knowledge from this article than what any other Dr has tried to explain to me.
I just had a STEMI (99% blocked) 2 DAYS AGO! At age 49!
Thanks
Glad you found it useful.
you can follow our twitter at @MustafaAhmedMD
Hello,
My husband had an anterior stemi in August 2018. He received one stent and is on several medications. He has three further blockages of around 70% which are managed with meds.
Lately he is feeling extreme exhaustion, short tempered and sometimes cold sweats. He is sleeping a lot more suddenly and I am wondering if he may be heading for another MI. He has suffered with anxiety since the Initial stemi and received some counselling to help him adjust to what has happened to him as 39 year old man.
Everyone says he will get back to normal, but I don’t think he will/we will ever be the same. He has a strong family history of heart disease with 3 out of five siblings having heart disease and his father. His older brother had a very serious heart attack at 37 which nearly killed him and another 12 months later. Having been tested for some certain type of cholesterol which is hereditary-he tested positive and they are now all going to have the test which I don’t believe is a standard practice. I don’t know how to tell the difference between symptoms of further heart disease or anxiety. What he experienced leading up to it was believed to be anxiety or severe indigestion. He was admitted prior to his MI and was released without treatment… he had a significant heart attack less than a week later.
I have recently suffered a SCAD (spontaneous coronary artery dissection) which led to a STEMI.
I have always been fit and active and have clear arteries. I understand this cause of heart attack is not well understood, so I am just taking this opportunity to raise awareness.
I will always be grateful to our wonderful NHS for saving my life.
Hi,
Great article thanks. I am a 45 male father of two, had a inferior STEMI about 16 weeks ago now. 100% blockage. Only just finished our sunday roast around the family dinner table and next minute i was being helicoptered to hospital.
No family history, been eating clean Paleo for 3+ years, BUT had VERY high cholesterol, also had been having the odd social cigarette.
Was seen to by first responders in about 20 minutes, so very lucky.
Was very anxious upon being let out of hospital, apparently this is normal while you process everything. But yea, i am still coming to terms with the seriousness of this.
Post follow ups say “we think youll be right for the next 10 years as long as 1. you take yr meds, 2. dont smoke, 3. exercise and 4.dont get stressed. After 10 years its 50/50”, lol, so yea its good to have goals yea… :/
Get busy creating those memories for your kids!
Cheers,
Gary
In September 2016 my beautiful man died on the way to hospital after suffering a stemi. He was 65 fighting fit, still working, never ill yet within a couple of hours my life was devastated when he died in the ambulance with me at his side. He had previously had a bit of heartburn, aching elbow yet nothing really which you would think was a heart attack, even when asked by the paramedics between 1-10 what was the pain, he said about 2. He was shocked twice in the ambulance but never recovered from the third event and the doctors did try in hospital but it was not to be. So everything you would believe looks like a heart attack in my case, this looked like heat stroke ..if only I had called NHS quicker my man may still be here so if in doubt…..don’t delay better safe than sorry.
After STEMI my echo shows
basal inferior and anteroseptal segments are thin scarred and akinetic
Lad 60% stenosis
with LVEF= 58
has my STEMI caused major damage to my heart and is there a possibility of heart failure
I’m 56 years old and on June 17, 2019 I had a ST elevation (STEMI) myocardial infarction. It was while I was at work and it was a sudden onset where I thought I just was overheated from the heat, after I get sick to my stomach I had a pain in my left side of the jaw that felt like somebody punched me hard, my boss called 911next thing i remember is waking up in the hospital and they told me i had 2 stents put in my right artery. The next day the doctor came in and said “I didn’t expect to see you here” he didn’t expect me to make it through the night cause he said i had had the widowmaker. I was able to leave the hospital 2 days later and returned to work the following week but did not know the entire severity of the attack until I read this information. From reading this I have learned a lot more information than my doctor ever told me. Thank you so much!
Glad you found it useful and are doing well.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Greetings;
I suffered an AMI/STEMI December 2, 2010, I coded three times after reaching the hospital. I’m classified as a critical care patient and a transplant candidate. I was never expected to survive the first three years without a transplant. I have been educating myself as to my heart conditions but this is the first that I’ve read placing a STEMI into category of severity.
Thank you so much for the information and the information that let’s me know I’m a survivor of the worst possible heart attack.
So glad you found this useful. Wonderful to hear you are doing well.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.