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NSTEMI: What You Need to Know

Overview

NSTEMI stands for non-ST segment elevation myocardial infarction, which is a type of heart attack. Compared to the more common type of heart attack known as STEMI, an NSTEMI is typically less damaging to your heart.

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NSTEMI vs. STEMI

NSTEMI vs. STEMI

Each heartbeat shows a visible waveform on an electrocardiogram (ECG). Although the clinical presentation and symptoms of NSTEMIs and STEMIs are the same, their waves look very different on an ECG.

An ECG will show the following characteristics for an NSTEMI:

  • depressed ST wave or T-wave inversion
  • no progression to Q wave
  • partial blockage of the coronary artery

A STEMI will show:

  • elevated ST wave
  • progression to Q wave
  • full blockage of the coronary artery

Both types of heart attack are considered acute coronary syndromes, a term that describes any blockage of blood supply to the heart muscle. As a result, NSTEMI and STEMI can lead to damage of the heart tissue.

Risk factors

NSTEMI risk factors

You’re much more likely to experience acute coronary syndrome such as NSTEMI if you have the following risk factors:

  • You smoke.
  • You’re physical inactivity.
  • You have high blood pressure or high cholesterol.
  • You have diabetes.
  • You’re overweight or obese.
  • Your family has a history of heart disease or stroke.
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Symptoms

Symptoms of NSTEMI

Symptoms of NSTEMI include:

  • shortness of breath
  • pressure, tightness, or discomfort in your chest
  • pain or discomfort in your jaw, neck, back, or stomach
  • dizziness
  • lightheadedness
  • nausea
  • sweating

Take these symptoms seriously if you experience them, and call 911 immediately. When it comes to chest pain and the other symptoms, it’s always better to err on the safe side and get help. If the symptoms are indeed those of a heart attack, every minute that passes without help can further increase damage to your heart.

Diagnosis

Diagnosing an NSTEMI

NSTEMI is diagnosed through a blood test and an ECG.

The blood test will show elevated levels of creatine kinase-myocardial band (CK-MB), troponin I, and troponin T. These markers are evidence of possible damage to the heart cells, and are typically mild compared with STEMI.

However, blood tests alone can’t diagnose a heart attack. The ECG will show the patterns of the ST waves, which will identify whether or not a heart attack occurred, and if so, which type.

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Treatment

NSTEMI treatment

Treatment will depend on the amount of blockage and the severity of the NSTEMI. A GRACE score will determine whether the cardiac event is low, medium, or high risk. This score uses these eight parameters to calculate risk:

  • age
  • heart rate
  • systolic blood pressure
  • Killip class (physical examination)
  • serum creatinine level
  • cardiac arrest at hospital admission
  • ST-segment deviation in ECG
  • elevated cardiac marker

Drug treatment is used for those who are low risk who’ve had an NSTEMI. Medications that may be given include anticoagulants, antiplatelets, beta-blockers, nitrates, statins, angiotensin-converting-enzyme (ACE) inhibitors, or angiotensin receptor blockers (ARBs).

For those with a medium to high risk, either a percutaneous coronary intervention (PCI) or a coronary artery bypass graft (CABG) is performed.

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Prevention

NSTEMI prevention

Lowering your risk factors can help prevent NSTEMI.

Lifestyle changes will have the biggest impact on your heart health. Focus on:

  • eating a well-balanced, heart-healthy diet that includes fruits, vegetables, whole grains, and healthy fats
  • limiting intake of saturated and trans fats
  • incorporating at least 30 minutes of physical activity five days per week
  • practicing stress management techniques such as yoga, deep breathing, or walking
  • quitting smoking
  • managing your weight

In addition, managing any current conditions such as diabetes, high cholesterol, and high blood pressure will be beneficial in preventing a heart attack. Speak with your doctor about the right path of prevention.

It’s also important to have an emergency action plan if you’re at higher risk for a heart attack, or if you’ve had one in the past. Keep lists of your medications and allergies handy in your wallet, as well as your healthcare provider’s phone numbers in case of an emergency.

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