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Postarrest Cardiocerebral Resuscitation: An Evidence-Based Review Dr. Jon Rittenberger

Postarrest Cardiocerebral Resuscitation:
An Evidence-Based Review
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Updated 11/10/2012
 
 
 
 

 

 


What is meant by STEMI and NSTEMI
in Angina, Heart Attacks or Heart Disease ?

The EKG (also called ECG) is one important tool in the diagnosis of heart disease. The EKG measures the flow of electrical impulses through the heart. In addition to detecting arrthymias, changes in the EKG can help determine if there is a lack of blood (ischemia) to a portion of the heart or if there is damage to an area of heart muscle.

STEMI vs NSTEMI
An EKG is one tool in evaluating ischemia in suspected heart attacks.

The flow of electrical impulses through the heart from the filling chambers (atria) to pumping chambers (ventricles) is labeled points P through T.
P through T = one heart beat.

One indicator of acute (sudden) lack of blood to the heart itself is an elevation of the S-->T line or ST segment. This is called ST segment elevation.
A patient with a heart attack or myocardial infarction, whose EKG shows ST segment elevation, is said to have STEMI or ST segment Myocardial Ischemia.

Not all patients with a lack of blood to the heart will have an EKG demonstrating ST segment elevation.
These patients are said to have Non ST Segment Elevation Myocardial Ischemia or Infarction called NSTEMI.

When a patient presents with symptoms of a heart attack, determining the EKG changes of STEMI versus NSTEMI are important in helping to determine the treatment pathway.

In brief, a patient with STEMI is often treated with drugs to try to destroy the blood clots that are clogging the coronary arteries (these drugs are called thrombolytics because a clot is also known as a thrombus). STEMI patients may also have a coronary evaluation for angioplasty or emergency bypass surgery.

Since NSTEMI patients may or may not have experienced a heart attack, NSTEMI patients may be treated with aspirin or other blood thinners and then followed with blood tests called cardiac markers. One blood test is a measurement of cardiac troponins. Troponin blood levels may rise in the hours after an episode of cardiac ischemia, indicating damage to the heart muscle.

It is important to remember that the above is simplified version of the often cloudy and complicated symptoms and findings surrounding angina, myocardial ischemia and heart attacks.

A more in depth explanation and protocol may be found in a downloadable pdf format from the Journal Circulation here.

Please seek immediate help if you think you may be experiencing symptoms of a heart attack and discuss your heart related questions with your medical providers.

STEMI vs Non STEMI Myocardial Infarction

Author Interview: Jacob Thomsen Lønborg, M.D. PhD

Influence of pre-infarction angina, collateral flow, and pre-procedural TIMI flow on myocardial salvage index by cardiac magnetic resonance in patients with ST-segment elevation myocardial infarction

Jacob Lønborg, Henning Kelbæk, Niels Vejlstrup, Hans Erik Bøtker, Won Yong Kim, Lene Holmvang, Erik Jørgensen, Steffen Helqvist, Kari Saunamäki, Leif Thuesen,Lars Romer Krusell, Peter Clemmensen, and Thomas Engstrøm

Eur J Echocardiogr first published online December 29, 2011 doi:10.1093/ejechocard/jer296

Delay From Symptom Onset to Hospital Presentation for Patients With Non-ST-Segment Elevation Myocardial Infarction.

Arch Intern Med. 2010 Nov 8;170(20):1834-41.

Ting HH, Chen AY, Roe MT, Chan PS, Spertus JA, Nallamothu BK, Sullivan MD, Delong ER, Bradley EH, Krumholz HM, Peterson ED.
Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905

 

 

 

 

Angina | Heart Disease Resourses | Chest Pain

Amazon.com Editorial Review:

Philips HeartStart Home Defibrillator (AED)

Be prepared for the unexpected.
When sudden cardiac arrest (SCA) strikes, the electrical system of the heart short circuits, causing the heart to quiver rather than pump in a normal rhythm. It typically results in the abnormal heart rhythm know as ventricular fibrillation (VF). It usually happens without warning and the majority of people have no previously recognized symptoms of heart disease. And it most often happens at home. For the best chance of survival from SCA caused by VF, a defibrillator should be used within 5 minutes. Yet, less than 1 in 20 people survive largely because a defibrillator does not arrive in time.
Just as seat belts or airbags do not save every life in a traffic accident, a defibrillator will not save every person who suffers a sudden cardiac arrest. Yet many lives could be saved if more people could be reached more quickly.

 

 

cardiac defibrillator, heart start defibrillator

Philips HeartStart Home Defibrillator (AED)

 

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