Definition
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.
Treatment
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.