Non-ST-Elevation

Myocardial Infarction
(NSTEMI)
BAES, FAITH CHRISLYN M. | 3B-PH
Non-ST-elevation Myocardial Infarction
- "intermediate" form of Acute Coronary Syndrome,
a blockage either occurs in a minor coronary artery
or causes partial obstruction of a major coronary
artery. It causes less damage to the heart.
How is a NSTEMI diagnosed?
when symptoms of unstable angina are accompanied by
evidence of myocardial necrosis
Electrocardiogram: ST depression and/or T Inversion
Cardiac troponin: by far the most commonly used
biomarker. It has the highest known sensitivity.
 DRUG THERAPY
Antithrombitic Agents:
Aspirin 325 mg:
- irreversible cyclooxygenase inhibitor
- helps to thin the blood and keep platelets in the blood
from clumping together
Clopidogrel 300-600 mg, Ticagrelor 180 mg, Prasugrel 60 mg:
- irreversibly binds to the P2Y12 receptor, except for
Ticagrelor
- adverse effects include gastrointestinal discomfort and
increased bleeding
Anticoagulant Agents:
Unfractionated heparin 60 U/kg
LWM heparin (Enoxaparin 1mg/kg SC)
Fondaparinux 2.5 mg SC
- work by inhibiting blood clotting, either by antagonizing the
effects of vitamin K or by blocking/inhibiting thrombin.
ADR: excessive bleeding, diarrhea, dizziness, and headaches
Anti-ischemic therapies:
Nitroglycerin 0.3-0.6 mg sublingually or buccal spray
- benefit by giving rise to nitric oxide (NO), which causes
vasodilation and increases blood flow to the myocardium

Beta blockers (Metoprolol 25-50 mg)

- slows the heart rate down and reduces the amount of work
the heart has to do
Long Term Management
Smoking cessation
Achieving optimal weight
Low in saturated and trans fat diet
Exercise
Continuation of drug therapies such as aspirin, clopidogrel,
beta-blocker, statins, ACE-inhibitors and ARBs
REFERENCES:
Ahmed, M. (2015, April 30). What’s a NSTEMI? Non ST Segment Myocardial Infarction. MyHeart.
https://myheart.net/articles/nstemi/#:%7E:text=NSTEMI%20stands%20for%20Non%2DST,to%20diagnose%20a%20
heart%20attack.
Antiplatelet and Anticoagulant Treatments for Unstable Angina/Non-ST Elevation Myocardial Infarction | Effective
Health Care Program. (2012). Agency for Healthcare Research and Quality.
https://effectivehealthcare.ahrq.gov/products/angina-heart-attack-treatments/research-protocol
Fogoros, R. (2020). NSTEMI: Non-ST-Segment Myocardial Infarction Explained. Verywell Health.
https://www.verywellhealth.com/non-st-segment-elevation-myocardial-infarction-nstemi-1746017
Heart Attack Treatment Guideline. (2013). CardioSmart. https://www.cardiosmart.org/news/2013/1/heart-attack-
treatment-guidelines
Longo, D., Fauci, A., Kasper, D., Hauser, S., Jameson, J., & Loscalzo, J. (2012). Harrisons Manual of Medicine, 18th
Edition (18th ed.). McGraw-Hill Education / Medical.