Non-ST Segment Elevation Myocardial Infarction

A heart attack occurs when a blood vessel on the surface of the heart (coronary artery) is blocked and interrupts blood supply to the heart muscle. This causes that area of the heart muscle to permanently scar. This blockage may be caused by cholesterol buildup (atherosclerotic plaque) within a coronary artery. The plaque cracks which creates a rough surface where blood cells attach, forming a clot.

Chest discomfort that happens with exertion and goes away with rest is called angina. This is a warning signal that blood flow to the heart is not enough. Angina that does not go away or becomes worse may mean that there is actual heart damage and a scar may form.

ST elevation refers to waveforms seen on an EKG or tracing of the electrical activity in the heart. Your provider can tell if there has been damage to your heart from changes in the normal pattern. A NSTEMI heart attack may be smaller and not as serious as one with typical changes. After an NSTEMI, there is a higher chance of another heart attack and returning angina after you have recovered.

CAUSES

  • Plaque in the coronary arteries. It builds up over many years.

  • Smoking. Smoking reduces the oxygen supply to the heart because carbon monoxide is more readily carried by the blood cells. Smoking also makes plaque develop faster. STOP SMOKING.

  • A narrowing (spasm) of a coronary artery.

  • Increased oxygen use. This can occur during extreme stress or activities.

  • Use of stimulants. Stimulants, such as cocaine and amphetamines, dangerously and unpredictably increase the oxygen needs of the heart. They can make the heart beat faster and unevenly. Stop using street drugs.

RISK FACTORS

  • Age–Risk increases with age for both men and women.

  • Menopause–After menopause and age 70, women have heart attacks at the same rate as men.

  • Diabetes–Maintaining a normal blood sugar and eating a balanced diet lessens the chance of a heart attack.

  • Obesity–Try to maintain a close to ideal body weight or as your caregiver suggests.

  • High blood pressure (hypertension)–Makes the heart work harder.

  • High cholesterol–Promotes the buildup of plaque in the blood vessels.

SYMPTOMS

Chest pain, especially if it radiates down the left arm, up into the neck, jaw or teeth, often comes from the heart. This is even more likely if the pain leaves with rest. Problems with the heart may mimic indigestion and anyone older than 35 should not ignore this symptom. Other typical problems (symptoms) include:

  • Profound sweating.

  • Feeling faint, weak or light-headed.

  • Feeling sick to your stomach.

  • Loss of normal color.

DIAGNOSIS

A combination of your history, an exam, EKG findings and blood work results determine if you have had a heart attack.

It is very important to seek medical care right away for episodes of chest pain. The sooner you get treatment, the sooner you may return to your normal activities. If a large area of heart muscle lacks oxygen and medical care is not provided; a weak heart muscle, heart failure or sudden death may result.

WHAT MAY HAPPEN IF A HEART ATTACK IS SUSPECTED

  • Aspirin may be given, if you are able to take it. This makes your blood "thinner" (less likely to clot).

  • Thrombolytics ("clot busters") may be given as long as it is safe and if a cardiac cath lab is not available.

  • A heart monitor will display the electrical activity of your heart to check for abnormal beats or rhythm.

  • An EKG is a painless procedure that gives information about areas of heart muscle that may be injured.

  • Your blood oxygen level may be monitored by a painless sensor attached to your finger or ear.

  • Blood tests are used to find out whether the heart muscle has been damaged.

  • A chest X-ray can give some indication of how well the heart and lungs are functioning.

  • A coronary angiogram may be performed. This is a procedure where dye is injected into your coronary arteries and x-rays are taken to determine which blood vessels are blocked.

  • Angioplasty or stent placement may be used during an angiogram to open a blocked vessel.

  • An echocardiogram is a painless and risk free external sonar exam that may be used to examine your heart valves, muscle function and blood flow within the heart.

TREATMENT

  • Length of hospital stays vary from a couple days to a week. This depends on the amount of heart damage and the severity of any complications.

  • If your symptoms are a false alarm and no heart disease is found, the stay is often less than 24 hours.

  • Medications may be used for reducing pain, keeping your heart beat regularly, helping your breathing and controlling your blood pressure.

  • Blood thinners may be used to dissolve clots.

  • If you have a single small artery blockage and no heart damage, you may have a balloon angioplasty. This procedure may displace the blockage and restore normal heart circulation. Stents most often follow angioplasty right away. Stents are small wire mesh-like tubes that help keep the artery open. The earlier this is done, the better.

  • Severe heart problems may require open heart surgery. This is a procedure where blocked arteries are bypassed with small veins from your legs or arteries from inside your chest wall. If important arteries are involved, or if your chest pain continues, this may be the best method to make ensure your long-term survival.

ABOUT YOUR HOSPITAL STAY

  • While you are in the hospital, you may be placed on a low salt, low fat diet and given a stool softener. The stool softener will keep you from straining during a bowel movement.

  • Oxygen may be given to increase oxygen delivery to the heart.

  • Medications may be prescribed, while in the hospital, to help your heart and lungs work better.

  • Before discharge from the hospital, a stress test may be performed. In this test, an ECG measures how well your heart works with exercise. The test may be done while you are walking on a treadmill, using a stationary bicycle or after being given medications to make your heart beat faster. It can be used to judge the safety of your proposed activity levels. It may provide a starting point for your exercise program.

HOME CARE INSTRUCTIONS

  • Follow the treatment plan your caregiver prescribes.

  • Carry medications, such as nitroglycerine, with you at all times, if directed.

  • Make a list of every medicine you are taking. Keep it up-to-date and with you all the time.

  • Get help from your caregiver or pharmacist to learn the following about each medicine:

  • Why you are taking it.

  • What time of day to take it.

  • Possible side effects.

  • Foods to take with it or avoid.

  • When to stop taking it.

  • Try to maintain normal blood lipid levels.

  • Eat a heart healthy diet with salt and fat restrictions as advised.

  • Activity Level–Everyone heals at a different rate. Decisions about when you may go back to work, start to exercise or have sex should be made with the guidance of your caregivers. Pace your activities to avoid shortness of breath or chest pain.

  • Weight Monitoring–Weigh yourself every day. You should weigh yourself in the morning after you urinate and before you eat breakfast. Wear the same amount of clothing when you weigh yourself. Record your weight daily. Bring your recorded weights to your clinic visits. Tell your caregiver right away if you have gained 3 lb/1.4 kg in 1 day or 5 lb/2.3 kg in a week.

  • Blood pressure monitoring–This should be done as often as you are told to check it. You can get a home blood pressure cuff at your drugstore. Record these values and bring them with you for your health checks.

  • Smoking–If you are currently a smoker, it is time to quit. Nicotine makes your heart work harder. Do not use nicotine gum or patches before checking with your doctor. Find a support group or therapist to help you quit.

  • Follow-up–Be sure to make and keep an appointment with your caregiver. Appointments with your cardiologist and other caregivers may also be needed.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have severe chest pain, especially if the pain is crushing or pressure-like and spreads to the arms, back, neck or jaw. THIS IS AN EMERGENCY. Do not wait to see if the pain will go away. Get medical help at once. Call your local emergency services (911 in the U.S.). DO NOT drive yourself to the hospital.

  • You start sweating, feel sick to your stomach or are short of breath.

  • Your weight increases by 3 lb/1.4 kg or more in 1 day or 5 lb/2.3 kg in a week.

  • You notice increasing shortness of breath during rest, sleeping or with activity.

  • You develop an increase in angina or develop chest pain which is unusual for you.

  • You are unable to sleep because you cannot breathe.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.