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A Guide to STEMI (ST-elevation Myocardial

Infarction) Heart Attacks

January 25, 2015 13347 4
Dr. Mustafa Ahmed
Have you or a loved one recently suffered from a STEMI (ST-elevation myocardial
infarction) heart attack? Are you a physician or med student looking for STEMI
diagnostic and treatment guidelines? This article is an all-encompassing STEMI
resource guide.

Patients Guide to STEMI

What is a STEMI Heart Attack?
A STEMI is a full-blown heart attack caused by the complete blockage of a heart artery.
A STEMI heart attack, like a Widow Maker, is taken very seriously and is a medical
emergency that needs immediate attention. For this reason its often called a CODE
STEMI or a STEMI alert. STEMI stands for ST elevation myocardial infarction. ST
elevation refers to a particular pattern on an EKG heart tracing and myocardial
infarction is the medical term for a heart attack. So STEMI is basically a heart attack
with a particular EKG heart-tracing pattern.

When someone is being evaluated for chest pain the EKG tracing is done as soon as
possible to help see if its the heart. An ST-elevation myocardial infarction (STEMI) is a
combination of symptoms of chest pain and a specific STEMI EKG heart tracing. The
EKG has to meet what is called STEMI criteria to make a correct diagnosis, just like
an NSTEMI will provide another set of specific diagnostic criteria. The EKG also
provides information as to which part of the heart the blocked artery is supplying, for
example an anterior vs. a posterior STEMI vs. an inferior STEMI. An anterior STEMI is
the front wall of the heart, and the most serious. A posterior STEMI is the back wall of
the heart. An inferior STEMI is the bottom wall of the heart.

What Happens to the Heart?

In a heart attack there is sudden rupture of an unstable part of the wall in a heart artery.
This leads to a build up of clot in an attempt to heal it however this clot formation results
in total blockage of the artery. Unfortunately this total blockage leads to loss of blood
supply to the heart beyond that point. The heart muscle stops working within minutes of
this and dies within minutes to hours unless the artery can be opened back up. For this
reason every minute from the onset of a heart attack is absolutely critical. Often the
patient doesnt make it to hospital due to sudden death. For those that leave it too long
or for those in whom the heart attack isnt treated, the heart muscle dies and is replaced
by a non beating scar.

The most important part of any STEMI treatment protocol is to get to the hospital as
quick as possible, so basically to call 911! In a STEMI an artery is blocked and
treatment centers on opening this up as quick as possible. The preferred way to do this
is by performing something known as angioplasty and stent placement. In this
procedure the artery is opened back up working through a small tube passed to the
heart either from the wrist or the groin. In some cases this cannot be performed fast
enough and to avoid a delay in treatment clot busting drugs are used. Unfortunately
these are not as good as they are less likely to open the artery back up and are also
associated with bleeding complications. They are better than no treatment at all though
so sometimes we have to use them.
In addition to this a number of other treatments are used. Painkillers such as morphine
are used to settle pain and reduce the anxiety. Oxygen is administered to those who are
breathless or have heart failure. EKG monitors are attached so that potentially lethal
arrhythmias such as ventricular fibrillation or even less dangerous but still significant
arrhythmias such as inappropriate sinus tachycardia or AFIB with RVR can be identified
and treated. Blood thinners such as heparin, aspirin and other platelet inhibitors
(clopidogrel/ticagrelor) are used to improve outcomes and prevent more heart attacks.

Post-STEMI Recovery
Educating patients and their families is one of the most critical aspects of care after a
STEMI. Several new medicines are started after a heart attack, several of which may be
needed lifelong. Patients need to be sure they take the medications prescribed to have
a benefit. Stopping smoking is essential. Its important patients follow up with their
doctors. Drugs should be used to control blood pressure such as amlodipine if
uncontrolled. After a STEMI patients will be enrolled in cardiac rehabilitation that is a
program they attend on a regular basis. This involves exercise, addressing questions
such as time of return to physical activities and dietary concerns. Following these things
after the STEMI is arguably as important as treating the STEMI itself.

Don't Forget NSTEMI.

Another type of heart attack similar to STEMI
Click Here to Learn About NSTEMI