A heart attack, also known as a myocardial infarction (MI), occurs when there is insufficient oxygen and nutrient delivery to portions of the heart resulting in heart muscle death. Often this involves obstruction of one or more coronary arteries by atherosclerosis. The process is such that cholesterol laden plaques develop on the inner lining of a vessel. Overtime, those plaques hamper blood flow and are prone to rupture. When this happens, platelets gather at the site of the ruptured plaque and, along with clotting factors, form a thrombus that acutely narrows the vessel diameter and severely reduces blood flow so that the heart muscle dies.
When this happens, there are 2 broad categories of heart attacks based on the appearance of the ECG: ST-segment elevation MI (STEMI) and non-ST segment elevation MI (NSTEMI). Both typically present with symproms of the acute coronary syndrome such as chest discomfort, breathlessness, nausea, sweating, etc. However, the STEMI is diagnosed by the appearance of the ECG and is treated with emergent stenting of the culprit vessel(s). On the other hand, NSTEMI often has normal or non-diagnostic ECG finding, and is instead diagnosed by elevations in cardiac biomarkers (troponin) that are released into the blood when heart muscle dies. In addition, NSTEMI is typically treated with medical optization (dual anti platelet therapy, anticoagulation, etc.) prior to cardiac cath and stenting unless certain high risk features are present.
It is important to note that not all troponin elevations are due to the acute coronary syndrome. We often see small troponin elevations in acute illnesses such as stroke, sepsis, pulmonary embolus, cocaine abuse, etc. Generally, these elevations are due to stress put on the heart (called demand ischemia), and do not require cardiac catheterization. Having said that, any detectable troponin levels are generally not good as this chemical is theoretically released only in response to heart muscle damage, and these small elevation do carry an poorer long term prognosis than those with undetectable troponin.
Moreover, a number of NSTEMIs are due to small vessel disease that cannot be detected on cardiac cath. These NSTEMIs are treated with lifestyle modification and optimal medical mgmt. These patients are also at increased adverse events over the long term compared to the general, healthy population.
I hope this helps.
citizensoldier16
03-04-17, 21:07
Sorry to hear this. First, let me say that I am a National Registry Paramedic (6 years) NOT an MD. NSTEMI is still a heart attack, it just won't show up on an ECG like a STEMI will. There really is too much info, so i will provide you the link below. It has good i formation and is easy to understand. As always, follow the orders of your doctor explicitly and don't take this lightly. Without proper management, it could happen again, or worse, a true STEMI is always possible. Best of luck. Don't miss cardiology appointments. Go religiously!
http://https://www.cardiosmart.org/Heart-Conditions/Guidelines/Heart-Attack-Guidelines
Edit: a positive troponin indicates cardiac cell death, indicative of heart attack.
I had a NSTEMI heart attack in January. I was on duty at the time and was about to go home for the night. I was not in any pain and not really in discomfort either but I definitely felt that something was wrong. I had someone call an ambulance to the station to check me out before I got on my motorcycle to go home. As pointed out by citizensoldier, the the ECG appeared normal and did not indicate heart attack. The EMT recommended I still take a ride to the ER and get full checked out since my blood pressure was 185/130. ECG at the ER still appeared normal and still no pain until about an hour after getting there. When blood test results came back I had a very slightly elevated troponin level that increased rather quickly with additional tests over the next several hours. Late the following day my blocked artery (LAD) was stented with a Bioresorbable stent device. I learned that I had a significant blockage in the LAD and was told that it was a really good thing that I'd had the presence of mind to get checked out considering the minor symtoms I initially had.
Prior to all of this. Back in late September I made a personal comittment to lose weight and get healthier. When I had my annual physical, my PCP had told me I was significantly overweight (which I already knew) and that I should immediately start doing something about it. I started on a semi-rigid Paleo diet plan and increased my activity level by walking for at least an hour/day. I immediately began losing weight. I had lost about 13-14 lbs by the end of the year. Mid January....BAM.... I'm back at it though and am now down a total of 25 lbs. It feels a lot better to go shopping for a new pair of pants to get smaller ones than bigger ones. I've still got the same belt and just keep putting more holes in it every other week or so. I'll buy a new one when I hit my goal as a reward and keep the old one to remind myself of how lazy and complacent I got.
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