NSTEMI

A non-ST-segment elevation myocardial infarction (NSTEMI, or non-STEMI) is a common type of heart attack. It occurs when a blood clot in one of your coronary arteries partly blocks blood flow. This condition gets its name because it doesn’t cause a specific electrical pattern called ST-segment elevation on an electrocardiogram (ECG/EKG) test. This makes it different from a STEMI.

Call 911 or your local emergency services number if you or someone you’re with has chest pain/discomfort or other heart attack symptoms. Delaying medical care can lead to permanent heart damage or death.

Symptoms of NSTEMI

NSTEMI symptoms are the same as those for any heart attack and include:

• Chest pain or discomfort
• Pain in your jaw, neck, shoulder, arm or back
• Shortness of breath
• Fatigue (extreme tiredness)
• Nausea or vomiting
• Anxiety
• Profuse sweating
• Dizziness or fainting

What causes a non-STEMI?

An NSTEMI happens when a blood clot forms over plaque in your coronary artery, causing a partial blockage. This can happen if you have coronary artery disease (plaque buildup in your heart’s arteries).

The plaque may build up over many years without causing problems. But if part of its surface wears away or breaks open, blood clots are drawn to that spot. The clots can quickly (over minutes to hours) narrow the space where blood can flow.

An NSTEMI means there’s still some room for blood to get through. But if the clotting continues, it can cause a total blockage. This means an NSTEMI can turn into a STEMI. And it’s a big reason why you need treatment right away for any heart attack symptoms.

Risk factors

These things raise your risk for an NSTEMI or any type of heart attack:

• A history of early coronary artery disease in your biological family
• Smoking or using any tobacco products
• Chronic kidney disease
• High blood pressure
• A diet high in sodium, saturated fat and/or sugar
• Not getting enough physical activity
• Using addictive substances, like amphetamines or cocaine
• Consuming too much alcohol

Complications of this condition

The reduced blood flow during an NSTEMI damages your heart muscle. The affected part of your heart can start dying. Your heart muscle can’t grow back or repair itself. That means the damage will be permanent unless blood flow is quickly restored.

Possible complications of an NSTEMI include:

• Additional heart attacks
• Repeat episodes of reduced blood flow to your heart
• Heart failure

Without treatment, an NSTEMI can also be fatal.

How doctors diagnose this condition

Healthcare providers diagnose an NSTEMI by doing a physical exam and running tests. They need to quickly learn if you’re having a heart attack, and if so, if it’s a STEMI or an NSTEMI. The exact type you’re having helps them plan treatment.

An EKG is one of the most important tests they’ll do. It shows your heart’s electrical activity as a wave on a graph. A heart attack can cause changes in the pattern that providers interpret. One part of the wave is called an ST-segment. A STEMI makes that part consistently taller than expected. But an NSTEMI doesn’t do that.

Instead, signs of an NSTEMI on an EKG may include:

• Transient ST-segment elevation: The segment is taller just for short periods.
• ST-segment depression: The segment drops below its normal baseline position.
• New T-wave inversion: A section called the T-wave is flipped from how it normally looks on your EKG. For example, if it normally curves upward (like a hill), it now curves downward (like a bowl).

Blood tests are also important for diagnosing NSTEMIs and other heart attacks. Your provider looks for raised levels of a chemical called troponin, which is a sign of heart muscle damage. You may also need imaging tests, like an echocardiogram, heart CT scan or heart MRI. These make detailed pictures of your heart and, depending on the specific test, can show things like blockages and heart damage.

How is an NSTEMI treated?

Healthcare providers use procedures and medicines to open your blocked coronary artery. They also give you medicines to help your heart work better and lower your risk of complications. Treatment of all heart attacks, including NSTEMIs, is time-sensitive. That means the faster blood flow is restored, the better.

Possible NSTEMI treatments include:

• Percutaneous coronary intervention (PCI): This procedure is a common heart attack treatment that saves many lives. A provider inflates a tiny balloon in your artery to clear the blockage. They usually also place a stent to keep the artery open.
• Coronary artery bypass grafting (CABG): This surgery helps people with severe blockages. A surgeon creates a new path for blood to go around (bypass) the problem area.
• Dual antiplatelet therapy: You take aspirin along with another drug. Together, these drugs stop platelets from bunching together to form clots. These medicines keep existing clots from growing and help prevent new ones.
• Anticoagulants: These drugs also lower your risk of blood clots.
• ACE inhibitors: These drugs lower your blood pressure. You’re more likely to need them if you have heart failure, high blood pressure, kidney problems or diabetes.
• Beta-blockers: These medicines slow your heart rate and make your heart pump with less force. This helps your heart work better with reduced blood flow.
• Nitroglycerin: This drug helps your chest pain go away.
• Statins: These medicines lower your blood cholesterol level. This helps limit plaque buildup in your arteries.

Recovery time

Your symptoms should start going away while you’re receiving treatment. Many people feel tired or weak for several days after a heart attack. It’s important to take things slow and let your body heal.

Cardiac rehab can help you strengthen your heart, feel better sooner and improve your chances of survival.

When should I see my healthcare provider?

Your provider will tell you how often you need follow-up visits. These are vital for your recovery and long-term health. They give your provider a chance to check your heart function and talk with you about how you’re feeling.

Call your provider any time you have new or changing symptoms, side effects from medicines or questions about your treatment plan.

If chest discomfort or other NSTEMI symptoms return, call 911 or your local emergency services number right away.

What can I expect if I have this condition?

The outlook for an NSTEMI depends on several things, including how much of your heart muscle is damaged. And if you’ve had any type of heart attack, your odds for having another go up.

Follow-up care and preventive measures are very important. This means taking your prescribed medicines and going to all of your check-ups. Your healthcare provider will explain what you can expect and how you can protect your heart.