STEMI vs NSTEMI

ST Elevation Myocardial Infarction (STEMI), a heart attack in which there is a COMPLETE blockage of a heart artery. As you can see it presents with an Elevation in the ST segment of the EKG wave.

A Non ST Elevation Myocardial Infarction (NSTEMI), a heart attack when there is a PARTIALLY blocked heart artery in which there is a severe blockage in blood flow. NSTEMI’s can present on an EKG as a depression on the ST segment or an inversion of the T Wave. REFER back to the last post to find out what these waves actually mean and what they coincide with the hearts conduction system

To distinguish between an NSTEMI or a STEMI, a 12 lead EKG will need to be done. Along with an EKG, many other things need to be done. In the Acute Phase of an MI, remember MONA and never forget your BLS and ACLS. Your Airway, Breathing, Circulation will determine the life or death of a patient who is experiencing an MI. MONA refers to Morphine(On top of it being an analgesic, it also decreases HR, BP, Venous Return which in turn decreases Myocardial oxygen demand), Oxygen, Nitroglycerin(potent Venous as Arterial Vasodilator) and Aspirin. Beta Blockers (-olol), ACE Inhibitors, ARB’s, Anti-Platelet, Thrombolysis
.
Labs need to be drawn on top of your BMP, CBC. Your cardiac enzymes:

• Troponin T and I ( Levels increase within 3-12hrs from onset of chest pain, peak at 24-48 hrs and return to baseline in 5-14 days. HIGHLY SENSITIVE TO CARDIAC MUSCLE DAMAGE
• Creatinine Kinase (CK-MB), Myoglobin, B Type Natriuretic peptide (BNP)

Treatments for STEMI or NSTEMI could vary demanding on the status of the patient. Certain patients could settle for a PCI (Balloon Angioplasty, Stents) others a Coronary Artery Bypass Graft, others are less fortunate and end up in Cardiogenic Shock with too much damage and the need for other measures are required. Some being:
-ECMO
-VAD placement
-Impella
-Use of Inotropes and Vasopressors
-Ventilators
-Intra Aortic Balloon Pump