NSTEMI
Formal Definition
Non-ST elevation myocardial infarction; a type of acute coronary syndrome characterized by myocardial necrosis (elevated troponins) in the absence of ST-segment elevation on ECG; distinguishes from unstable angina by the presence of biomarker elevation and from STEMI by the absence of ST elevation; requires risk stratification and either an early invasive strategy (coronary angiography within 24-72 hours) or conservative management depending on risk score.
How It's Used on the Ward
NSTEMI or non-STEMI or subendo — the heart attack without the dramatic ST elevations on the ECG; troponins are up, the patient is having real tissue death.
Example
"58-year-old diabetic male, CP pressure 2h, EKG shows ST depressions in V1-V4, troponin I 4.2 ng/mL (normal <0.04). Diagnosis: NSTEMI. Heparin drip initiated, cardiology consulted for risk stratification and angiography within 24h. Plavix 300mg loading dose given."
Clinical Context
NSTEMI vs STEMI: STEMI = coronary occlusion, needs emergent PCI (door-to-balloon <90 min); NSTEMI = partial occlusion or supply-demand mismatch, stabilization + risk stratification first. Risk scores: TIMI (0-7), GRACE (for in-hospital mortality). TIMI 5-7 = high risk → early invasive (<24h). NSTEMI management: dual antiplatelet therapy (aspirin + P2Y12 inhibitor), anticoagulation (heparin), beta-blocker, statin, ACE inhibitor. Type 1 NSTEMI = atherosclerotic plaque rupture; Type 2 = supply-demand mismatch (anemia, arrhythmia, hypotension). Troponin rise: peak at 12-24h, normalize over 7-10 days.