ECG for Beginners. ECG Diagnosis of ST Elevation Myocardial Infarction (STEMI)
How to Treat Nstemi
An NSTEMI (non-ST-elevation myocardial infarction) is a type of heart attack that usually involves a partial or temporary blockage. It's usually revealed in an EKG. Like all heart attacks, an NSTEMI is an emergency and requires immediate medical care. If you’re generally healthy, you might only need medication. If you have a history of heart issues or other risk factors, the best treatment is a procedure called angioplasty. Having a heart attack is frightening, but healthy lifestyle changes can reduce your risk for heart issues in the future.
Administering First Aid
Call emergency services for symptoms of a heart attack.Signs of a heart attack include chest pain or discomfort; pain or numbness in the arms, neck, back, or jaw; shortness of breath; and dizziness. Symptoms can be subtle, but if you suspect you’re having a heart attack, seeking immediate medical attention is essential.
- Pain in the middle of your chest, or angina, may come and go. It may feel like squeezing or uncomfortable pressure. Pain or discomfort may become gradually more intense, go away, then return.
- If you’re on the fence about your symptoms, err on the side of caution. Heart attacks sometimes have few symptoms and may even feel like indigestion or muscle pain. If you’re having a heart attack, you’ll have better chances of recovering if you receive prompt treatment.
Sit down, rest, and try to stay calm.As frightening as the experience may be, do your best to remain calm. Try to control your breathing, inhale slowly and deeply, and sit or lie down with your upper body elevated, such as in a chair or with pillows propping you up.
- Stop any activities you’re doing and don’t walk around.
- Exerting yourself could worsen your condition.
Chew or crush aspirin as directed by the emergency responders.The emergency services operator or responders will likely tell you to take an aspirin. Crushing or chewing it will allow your body to absorb it faster.
- Usually, doctors recommend that you take 82.5 mcg of aspirin to prevent a heart attack. This is the amount in a children's aspirin and is equal to about 1/4 of an adult aspirin.
- If you’re with someone who’s having a heart attack, don’t give them any medication without consulting first responders, especially if they’re unconscious or incoherent. You wouldn’t know if they’re allergic or take medications that shouldn’t be mixed with aspirin.Instead, try to get as much information from them while they're alert, such as the medications they're on and what they've taken that day. Ask them if they've been prescribed a pill that dissolves under their tongue, as well as where it is if they have. If they do have a prescription, you can help them take the pill, which is called nitrotryclyceride, by placing it under their tongue.
Take medication for chest pain, if you’ve been prescribed one.If you have a history of heart disease or angina, you might take a prescription medication, such as nitroglycerin. Take your medication as prescribed when you experience chest pain. If pain persists for more than 3 minutes, call emergency services.
- Follow your doctor's instructions. In most cases, you'll take 1 pill every 10 minutes as you experience pain, for up to 3 doses. Be sure to tell the emergency responders, or anyone who is with you at the time, what you have taken, as well as how much.
Administer CPR after calling for help, if necessary.If you suspect someone is having a heart attack and they’re unconscious, call emergency services immediately. After getting help, begin to administer CPR, if you’re trained.
- To administer CPR, place one hand directly over the center of the chest and your other hand on top of the first. Press hard, fast, and evenly into the chest at about 100 beats per minute.
- If the person isn’t responsive and you’re confident you can perform CPR, attempt it, even if you haven't completed your certification or it's lapsed. CPR can double or even triple their survival rate.
- If you’re not trained or aren’t confident that you could attempt CPR, see if there’s anyone nearby who can. You can also have an EMT coach you through the process via the phone.
Diagnosing an NSTEMI Heart Attack
Report your symptoms and risk factors, if possible.If you can communicate, emergency responders and other healthcare providers will ask about your symptoms and overall health. Tell them your age, about any medications you take, if you have a history of heart disease, and if you have any medical conditions.
- If you’re unable to communicate, they might ask any friends or relatives present about your health. If you can, give someone your phone so that they can call friends and relatives to get more information about your health so that they can help you get treatment.
- If your healthcare providers can’t access information about your medical history, diagnostic tests can still help them come up with the right treatment plan.
Try to stay calm while undergoing tests.Getting blood drawn, having your heart monitored, and undergoing other procedures can be a lot to handle. Do your best to relax and stay positive. Remind yourself that the tests are essential in order for your doctors and nurses to provide the right treatment.
- Diagnosing types of heart attack can be tricky, but the right treatment depends on the specific condition. STEMI (ST-elevation myocardial infarction) and NSTEMI heart attacks involve different blockage types and require distinct treatment methods. With an NSTEMI heart attack, the doctor is able to see changes on your EKG, which indicate a blockage.
- A STEMI heart attack involves a complete blockage, and the priority is to clear the artery as soon as possible.
- An NSTEMI heart attack usually involves a partial or temporary blockage. While an NSTEMI heart attack is still an emergency situation, the need to clear the blockage isn’t as immediate.
Get an ECG to find if the heart attack is STEMI or NSTEMI.An electrocardiogram (ECG) is the first way to diagnose an NSTEMI heart attack. An ECG detects markers in the heart’s electrical activity that help doctors diagnose specific heart conditions.
- Special stickers placed on your chest and limbs detect your heart’s electrical activity. An ECG is non-invasive and doesn’t hurt at all.
- If you're having a heart attack, your ECG will show ST elevations, which tells the doctor you have a blockage.
Have your blood tested for signs of heart damage.Your healthcare providers will also check your for substances that indicate heart damage, such as troponin. The heart releases troponin when it’s damaged or under stress. The amount present in your blood will help your healthcare providers assess your condition.
- It's best to get your troponin tested as early as possible, as they can decrease on their own over time. However, the damage may remain and needs to be treated.
Undergo imaging and stress tests, if necessary.Your cardiologist might order further tests if there is no clear diagnosis after ECG and blood work. They might need to examine the blockage by inserting a special tube into the artery. They might also have you take a treadmill stress test, or take your ECG readings while you exercise.
- If they have to examine the blockage, they’ll numb an area on your arm, leg, or groin, then insert a small tube called a catheter into an artery. This device will help them find the blockage and determine its severity.
- In many cases, this procedure, which is called catheterization, isn’t necessary for an NSTEMI heart attack.
Receiving Immediate Treatment
Ask your cardiologist to explain the 2 recommended treatment paths.If you’ve never had any heart issues and are in good health, your doctor will likely recommend conservative treatment, or medication only. If you have a history of heart disease or other medical conditions, they’ll likely recommend a more aggressive option, such as angioplasty.
- During angioplasty, the doctor installs a tube in your artery that has a balloon at the end of it. Once it's in place, it will push the plaque that is blocking your arteries out against the wall of your artery, which allows the blood to flow more freely through your veins.
- Ask your healthcare providers, “Which treatment option do you recommend? If I receive medication only, are there any risks of putting off more aggressive treatment? Do I fall into any high-risk categories that call for more aggressive treatment?”
- In most cases, high risk patients have a history of heart disease, are overweight or obese, smoke, and/or have high cholesterol. You may also be considered high risk if your ST elevations are very high, or you have high levels of troponin.
Manage NSTEMI with medication if you’re generally healthy.The first treatment method is called a noninvasive or conservative strategy. You’ll take medications to help ease your heart’s workload, such as blood thinners. Your healthcare providers will keep you in the hospital and monitor you to make sure your chest pain goes away, ECG readings improve, and blood work shows signs of recovery.
- You’ll likely receive some medications, most likely a blood thinner, via IV (intravenously) and take others orally. After you’re discharged from the hospital, your doctor will prescribe oral heart medications.
- Side effects may include dizziness, nausea, headache, bruising, and bleeding. Ask your doctor about possible side effects of your specific prescriptions.
- Once your pain goes away and the doctor ensures that you are recovering, you may be sent home as long as you continue taking your medication.
Get an angioplasty if you have a history or high risk of heart issues.The second treatment method, called an invasive strategy, involves heart medication and a procedure called angioplasty. This is the best treatment if you have a history of heart disease, if your test results were high-risk (such as high troponin levels or a life-threatening irregular heartbeat), if your chest pain doesn’t go away, or if conservative treatment fails.
- During an angioplasty, a cardiologist clears a blockage or widens an inflamed artery using a thin tube fitted with a special balloon. The tube is inserted into an area on a limb or groin.
- While you’ll be awake for the procedure, you’ll receive a local anesthetic and mild sedative, so you won’t feel any pain.
- Your doctor will be there with you at all times to ensure that the procedure goes smoothly.
- Most patients recover from angioplasty quickly, and you should be able to walk in 4 to 6 hours.
- Your doctor will tell you how to care for the incision site. You'll need to keep the area dry and bandaged for 24 to 48 hours. For 2 to 5 days, you'll need to clean the area and change the bandage at least once a day.
Diagnose and treat the underlying cause of the NSTEMI, if necessary.NSTEMI heart attacks aren’t always due to coronary artery disease, which is when plaque builds up in the arteries. If the doctor determines that your heart attack wasn't caused by plaque, then they'll do tests to identify what caused your ST elevations. They can be caused by kidney failure, respiratory failure, severe infection, and other medical conditions. If necessary, you’ll need to receive treatment for any underlying issues that may have caused the heart attack.
- Treatment depends on the specific condition. If your NSTEMI was not caused by plaque, then the doctor will determine which treatment path is right for you.
Recovering from a Heart Attack
Expect to recover in the hospital for a few days.The amount of time you’ll spend in the hospital depends on the severity of the heart attack. When you’re ready to go home, your healthcare providers will give you instructions about getting rest, eating healthy, taking your medication and, if necessary, caring for an incision site.
- If you had a catheterization or angioplasty, you’ll need to keep the area dry for 24 to 48 hours. Your doctor will let you know when to change the bandage for the first time. For 2 to 5 days, you’ll need to clean the area and change the dressing at least once a day.
Take medications for your heart as directed.Your doctor will prescribe medications that you might need to take indefinitely. Take any medication as directed, and never stop taking your medicine without consulting your doctor.
- Medications that help protect your heart might include a blood thinner, an ACE inhibitor to dilate your blood vessels, and a beta blocker to reduce blood pressure. You might also need to take drugs to manage high blood pressure and cholesterol.
- Additionally, your doctor will probably recommend taking a small dose of aspirin daily.
Make heart-healthy dietary changes.Eating healthy after a heart attack is vital. Avoid saturated and trans fats, which are found in red meat, desserts and pastries, and candy. You’ll also need to limit your salt intake to around 1500 mg per day.
- Your diet should consist mainly of fruits, vegetables, whole grains, and lean proteins, such as boneless, skinless poultry and seafood.
- Additionally, don’t drink alcohol for 2 weeks after the heart attack, or longer if your doctor advises. Thereafter, limit your alcohol consumption to 2 drinks per day if you’re a man, and 1 drink per day if you’re a woman.
Rest as much as possible for 4 to 6 weeks.It’ll take some time to resume you normal activities, but try to stay positive. Remind yourself that things will start to feel normal again soon. In the meantime, try to get at least 8 hours of sleep each night, take naps if you feel tired, and avoid strenuous activities.
- As a rule of thumb, stop doing an activity if you can’t talk normally because you’re winded.
- Try to hang out with loved ones, especially if you’re bored or feeling depressed. Doing relaxing activities with friends and relatives can help you stay positive during the downtime.
Begin easy exercises according to your doctor’s instructions.You might need to take a stress test before starting to exercise. While you’ll need to start slow, staying physically active will help promote heart health.
- When you’re ready to start exercising, your doctor might have you walk for about 5 minutes 2 to 3 times a day.
- After a week, you might start walking for 10 minutes, then increase your time by 5 minutes a week for 6 weeks. By that time, you’ll probably be ready to other activities, such as swimming.
Consult your cardiologist about when you can return to work.After you’re discharged from the hospital, you’ll need to take at least a week off from work. Your cardiologist might advise you stay home longer. Depending on your occupation, you might want to ask your doctor for advice about managing work-related stress.
- If you juggle a lot of responsibilities at work, do your best to avoid spreading yourself too thin. Talk to your supervisor about your medical needs, and ask coworkers for help if you have too much on your plate.
Manage any underlying causes of the heart attack.Since NSTEMI heart attacks aren’t always caused by plaque in the arteries, you might need to address any chronic medical conditions related to the heart attack. Your doctor will work with you to develop a plan to treat or manage your specific condition.
- For example, you might need to take daily medications to manage a respiratory illness.
- While medications and medical care can clear blockages and protect your heart, they don’t treat the causes of the heart attack. Heart-healthy lifestyle changes are essential to treating and recovering from a heart attack.
Video: Acute Coronary Syndrome DETAILED Overview (MI, STEMI, NSTEMI)
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