NSTEMI: Symptoms, Diagnosis, and How It Compares to STEMI

Risk factors HealthConditionsDiscoverPlanConnectShopSubscribeParenthoodStagesInfertilityHealth&Well-BeingLifeSex&RelationshipsProducts&GearNSTEMI:WhatYouNeedtoKnowMedicallyreviewedbyDebraSullivan,Ph.D.,MSN,R.N.,CNE,COI—WrittenbyNatalieOlsen,R.D.,L.D.,ACSMEP-C—UpdatedonAugust31,2017NSTEMIvs.STEMIRiskfactorsSymptomsDiagnosisTreatmentPreventionOverviewNSTEMIstandsfornon-STsegmentelevationmyocardialinfarction,whichisatypeofheartattack.ComparedtothemorecommontypeofheartattackknownasSTEMI,anNSTEMIistypicallylessdamagingtoyourheart.NSTEMIvs.STEMIEachheartbeatshowsavisiblewaveformonanelectrocardiogram(ECG).AlthoughtheclinicalpresentationandsymptomsofNSTEMIsandSTEMIsarethesame,theirwaveslookverydifferentonanECG.AnECGwillshowthefollowingcharacteristicsforanNSTEMI:depressedSTwaveorT-waveinversionnoprogressiontoQwavepartialblockageofthecoronaryarteryASTEMIwillshow:elevatedSTwaveprogressiontoQwavefullblockageofthecoronaryarteryBothtypesofheartattackareconsideredacutecoronarysyndromes,atermthatdescribesanyblockageofbloodsupplytotheheartmuscle.Asaresult,NSTEMIandSTEMIcanleadtodamageofthehearttissue.NSTEMIriskfactorsYou’remuchmorelikelytoexperienceacutecoronarysyndromesuchasNSTEMIifyouhavethefollowingriskfactors:Yousmoke.You’rephysicalinactivity.Youhavehighbloodpressureorhighcholesterol.Youhavediabetes.You’reoverweightorobese.Yourfamilyhasahistoryofheartdiseaseorstroke.SymptomsofNSTEMISymptomsofNSTEMIinclude:shortnessofbreathpressure,tightness,ordiscomfortinyourchestpainordiscomfortinyourjaw,neck,back,orstomachdizzinesslightheadednessnauseasweatingTakethesesymptomsseriouslyifyouexperiencethem,andcall911immediately.Whenitcomestochestpainandtheothersymptoms,it’salwaysbettertoerronthesafesideandgethelp.Ifthesymptomsareindeedthoseofaheartattack,everyminutethatpasseswithouthelpcanfurtherincreasedamagetoyourheart.DiagnosinganNSTEMINSTEMIisdiagnosedthroughabloodtestandanECG.Thebloodtestwillshowelevatedlevelsofcreatinekinase-myocardialband(CK-MB),troponinI,andtroponinT.Thesemarkersareevidenceofpossibledamagetotheheartcells,andaretypicallymildcomparedwithSTEMI.However,bloodtestsalonecan’tdiagnoseaheartattack.TheECGwillshowthepatternsoftheSTwaves,whichwillidentifywhetherornotaheartattackoccurred,andifso,whichtype.NSTEMItreatmentTreatmentwilldependontheamountofblockageandtheseverityoftheNSTEMI.AGRACEscorewilldeterminewhetherthecardiaceventislow,medium,orhighrisk.Thisscoreusestheseeightparameterstocalculaterisk:ageheartratesystolicbloodpressureKillipclass(physicalexamination)serumcreatininelevelcardiacarrestathospitaladmissionST-segmentdeviationinECGelevatedcardiacmarkerDrugtreatmentisusedforthosewhoarelowriskwho’vehadanNSTEMI.Medicationsthatmaybegivenincludeanticoagulants,antiplatelets,beta-blockers,nitrates,statins,angiotensin-converting-enzyme(ACE)inhibitors,orangiotensinreceptorblockers(ARBs).Forthosewithamediumtohighrisk,eitherapercutaneouscoronaryintervention(PCI)oracoronaryarterybypassgraft(CABG)isperformed.NSTEMIpreventionLoweringyourriskfactorscanhelppreventNSTEMI.Lifestylechangeswillhavethebiggestimpactonyourhearthealth.Focuson:eatingawell-balanced,heart-healthydietthatincludesfruits,vegetables,wholegrains,andhealthyfatslimitingintakeofsaturatedandtransfatsincorporatingatleast30minutesofphysicalactivityfivedaysperweekpracticingstressmanagementtechniquessuchasyoga,deepbreathing,orwalkingquittingsmokingmanagingyourweightInaddition,managinganycurrentconditionssuchasdiabetes,highcholesterol,andhighbloodpressurewillbebeneficialinpreventingaheartattack.Speakwithyourdoctorabouttherightpathofprevention.It’salsoimportanttohaveanemergencyactionplanifyou’reathigherriskforaheartattack,orifyou’vehadoneinthepast.Keeplistsofyourmedicationsandallergieshandyinyourwallet,aswellasyourhealthcareprovider’sphonenumbersincaseofanemergency.LastmedicallyreviewedonAugust31,20175sourcescollapsedHealthlinehasstrictsourcingguidelinesandreliesonpeer-reviewedstudies,academicresearchinstitutions,andmedicalassociations.Weavoidusingtertiaryreferences.Youcanlearnmoreabouthowweensureourcontentisaccurateandcurrentbyreadingoureditorialpolicy.Acutecoronarysyndrome.(2017).heart.org/HEARTORG/Conditions/HeartAttack/AboutHeartAttacks/Acute-Coronary-Syndrome_UCM_428752_Article.jsp#.WXFQXhPytE8AmericanHeartAssociationrecommendationsforphysicalactivityinadults.(2014).heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/American-Heart-Association-Recommendations-for-Physical-Activity-in-Adults_UCM_307976_Article.jsp#.WXJH4zPMzUITheGRACEriskscore:Assessingheartattackriskandguidingtreatment.(2016).ed.ac.uk/research/impact/medicine-vet-medicine/graceHowcanaheartattackbeprevented?(2015).nhlbi.nih.gov/health/health-topics/topics/heartattack/preventionSmithJN,etal.(2015).Diagnosisandmanagementofacutecoronarysyndrome:Anevidence-basedupdate.DOI:10.3122/jabfm.2015.02.140189FEEDBACK:MedicallyreviewedbyDebraSullivan,Ph.D.,MSN,R.N.,CNE,COI—WrittenbyNatalieOlsen,R.D.,L.D.,ACSMEP-C—UpdatedonAugust31,2017ReadthisnextCausesandRisksofHeartDiseaseMedicallyreviewedbyGerhardWhitworth,R.N.Coro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