Frequency of Patients with NSTEMI Electrocardiographic Changes that Have Potential to Become STEMI

Suling, Frits R.W (2020) Frequency of Patients with NSTEMI Electrocardiographic Changes that Have Potential to Become STEMI. Solid State Technology, 63 (3). pp. 5048-5056. ISSN 0038 111x

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Abstract

Acute Coronary Syndrome (ACS) can be divided into a subgroup of ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and Unstable Angina (UA). ACS carries significant morbidity and mortality and the prompt diagnosis, and appropriate treatment is essential. STEMI diagnosis and management are discussed elsewhere. NSTEMI and unstable angina are very similar, with NSTEMI having positive cardiac biomarkers. While the cause of this mismatch in STEMI is nearly always coronary plaque rupture resulting in thrombosis formation occluding a coronary artery, there are several potential causes of this mismatch in NSTEMI. There may be a flow-limiting condition such as a stable plaque, vasospasm as in Prinzmental angina, coronary embolism, or coronary arteritis. The "typical" presentation of NSTEMI is a pressure-like substernal pain, occurring at rest or with minimal exertion. The pain generally lasts more than 10 minutes and may radiate to either arm, the neck, or the jaw. History, ECG, and cardiac biomarkers are the mainstays in the evaluation. An ECG should be performed as soon as possible in patients presenting with chest pain or those with a concern for ACS. A normal ECG does not exclude ACS and NSTEMI. ST-elevation or anterior ST depression should be considered a STEMI until proven otherwise and treated as such. Findings suggestive of NSTEMI include transient ST elevation, ST depression, or new T wave inversions. ECG should be repeated at predetermined intervals or if symptoms return.

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