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So-called "STEMIs" are the most severe kind of heart attack. What do you need to know about these myocardial infarctions?

STEMI is short for “ST-Elevation Myocardial Infarction”, and it’s the medical abbreviation used to describe the most common type of heart attack. Like other heart attacks, it is the result of blood supply being interrupted, which causes damage to the heart’s muscle. The name of this type of heart attack refers to the location of the problem on the electrocardiogram.

Types of STEMIs

When there is a blockage in one of the coronary arteries and it prevents blood from reaching your heart, your heart’s muscle slowly withers away. The ST segment is located on the flat region of a person’s EKG chart. This is the interval represented between two heartbeats. People who have experienced a STEMI will have this portion of their reading elevated instead of flat.

STEMI is caused by acute coronary syndrome, a problem that appears when fatty deposits known as plaques rupture, leading to blood clots that temporarily or permanently block the coronary arteries. As this happens, the portion of the heart which is linked to the blocked coronary artery lacks oxygen, causing the tissue to die. This particular occurrence is known as ischemia. At this point, a person is likely to experience chest pain, also known as angina, which is typically considered the most common sign of a heart attack.

There are different types of acute coronary syndrome, labeled depending on the level of the obstruction and the damage it’s caused:

  • STEMI is one type of heart attack that occurs as a result of coronary artery obstruction, leading to the death of heart muscle tissue. It is the most severe form of the acute coronary syndrome.
  • A person can also have unstable angina, a condition in which blood clots that can dissolve and reform over a short period of time are present. This makes the obstruction of the coronary artery only temporary. In this particular situation, a person will experience chest pain even when at rest, which is unpredictable, thus the name of unstable angina.
  • People can also experience partial heart attacks. This means that there is a blood flow restriction in the coronary arteries, but it does not fully obstruct blood from flowing through the vessels. It does produce damage, in the sense that some cells will die, but some muscle parts survive. This type of heart attack is formally referred to as an NSTEMI (short for “non-ST-segment elevation myocardial infarction”.
While different from one another, all of these heart attacks are severe and should be treated accordingly. Even if STEMI is the most serious type, NSTEMIs and unstable angina could be signs of a full-blown heart attack and should be treated as medical emergencies.

Symptoms of STEMI

The clearest and most frequent indicator of this type of heart attack is chest pain. In women, it’s common for this pain to extend to other parts of the body, such as the neck, shoulders, or jaw. Other symptoms of STEMI can also include shortness of breath, anxiety, and excessive sweating. However, it’s important to keep in mind that pain can be felt differently by each person, so you can expect chest pain in your particular case to be different. It could feel more like tightness, squeeze, or pressure.

You should also take notice if you experience any extreme fatigue, dizziness, and irregular heartbeats, if you’re feeling lightheaded, or like you want to throw up, or if you feel you have heartburn or indigestion (symptoms of a heart attack are often mistaken for indigestion).

Diagnosis of STEMI

STEMI is quite an easy problem to diagnose, especially since the EKG makes the issue very visible. Based on your symptoms and your EKG readings, doctors can establish a treatment plan immediately, Cardiac enzymes might also help in the diagnosis of a STEMI, but their results are typically later than the actual starting moment of the treatment plan.

People who end up in the emergency room will receive medical help immediately. This is particularly important because STEMI can lead to ventricular fibrillation, which causes the heart to beat out of its usual rhythm. It can also lead to acute heart failure, as the heart is less and less capable of pumping the blood it needs to survive. Both of these complications can lead to death.

STEMIs can result in permanent damage, and chronic heart failure is one of the most common outcomes. Another possible result is having an irregular heartbeat, also known as arrhythmia.

Treatment of STEMI

When someone arrives in the emergency room with this type of heart attack, the first priority of the doctors is to make sure the patient is stabilized, and the coronary artery is opened as soon as possible. This typically implies administering a series of drugs to the patient, which are meant to stabilize the heart muscle. These include statins or morphine, to name a few. Then, doctors proceed to reopen the coronary artery.

At this point, it’s all a matter of speed:

  • When the artery is opened within three hours of the blockage, you get the best outcome.
  • Six hours after the blockage, doctors can minimize most of the damage.
  • 12 hours after the blockage, patients are more likely to end up with permanent damage.

It is up to the doctors to decide which intervention might be more suitable in your case, but this depends on your age and current health status. Some STEMIs can be treated with clot-busting drugs, and won’t require other aggressive interventions. In other cases, angioplasty with stent placement might be the best option.

What happens after?

People who have suffered from a heart attack and survived have to pay close attention to their heart health for the rest of their lives. Once muscle tissue has been compromised, you are more exposed to experiencing this medical emergency once more. The majority of heart attack suffers won’t just have to make lifestyle changes, but will be required to take medication for extended periods of time, and do regular check-ups to see how their condition is evolving, and if they are responding to treatment.

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