Myocardial infarction, commonly referred to as a heart attack, is a serious and potentially life-threatening condition that occurs when the blood supply to the heart muscle is blocked, leading to damage or death of heart tissue. St elevation myocardial infarction (STEMI) is a type of heart attack that is characterized by a specific pattern on an electrocardiogram (ECG), indicating damage to the heart muscle.
Symptoms of STEMI may include:
- Chest pain or discomfort: This may feel like a heavy pressure or tightness in the chest, and may be accompanied by pain radiating to the arms, neck, jaw, back, or stomach.
- Shortness of breath: This may occur with or without chest pain, and may get worse over time.
- Nausea or vomiting: This can occur due to the discomfort associated with the heart attack.
- Lightheadedness or fainting: This can occur due to the reduced blood flow to the heart.
- Sweating: This may be accompanied by a cold, clammy feeling.
STEMI is diagnosed through a combination of clinical examination, ECG, and blood tests to measure cardiac biomarkers. A definitive diagnosis can usually be made in the emergency department, and patients with suspected STEMI are usually referred immediately for further investigation and treatment.
The standard of care for STEMI is prompt recognition and management, including:
- Emergency medical services (EMS): Call for an ambulance immediately if you suspect you are having a heart attack.
- Thrombolytic therapy: This involves administering clot-busting medications to dissolve the blood clot blocking the blood supply to the heart.
- Primary percutaneous coronary intervention (PCI): This is a procedure where a cardiologist uses a catheter to access the blocked coronary artery and restore blood flow to the heart. PCI is the preferred treatment for STEMI and has been shown to improve outcomes compared to thrombolysis alone.
- Secondary prevention: This involves managing risk factors such as high blood pressure, high cholesterol, smoking, and diabetes to reduce the risk of further cardiac events.
Time is of the essence in the diagnosis and treatment of STEMI, as early intervention can improve outcomes and reduce the risk of complications. The American Heart Association recommends that patients with suspected STEMI be taken to a hospital with PCI capabilities within 90 minutes of the onset of symptoms.
Complications of STEMI can include:
- Heart failure: This occurs when the heart is unable to pump blood effectively, leading to fluid buildup in the lungs and other organs.
- Arrhythmias: This refers to an abnormal heart rhythm, which can be life-threatening if not treated promptly.
- Sudden cardiac death: This can occur if the heart stops beating suddenly due to a severe arrhythmia.
- Recurrent myocardial infarction: This can occur if the blood supply to the heart is not restored or if the heart damage is not properly managed.
Risk factors for STEMI include:
- Age: The risk of STEMI increases with age, particularly for men over the age of 45 and women over the age of 55.
- Family history of heart disease: A history of heart disease in first-degree relatives (parents, siblings) increases the risk of STEMI.
- Smoking: Smoking significantly increases the risk of STEMI.
- High blood pressure: High blood pressure damages the blood vessels over time, increasing the risk of blockages.
- High cholesterol: High levels of low-density lipoprotein (LDL) cholesterol increase the risk of plaque buildup in the arteries.
- Diabetes: People with diabetes are
After receiving a stent in a primary percutaneous coronary intervention (PCI) for a STEMI, the typical treatment and follow-up care includes:
- Antiplatelet therapy: Patients are typically prescribed antiplatelet medications such as aspirin and clopidogrel to prevent blood clots from forming around the stent. These medications are usually taken for at least a year.
- Anticoagulation therapy: Patients may also be prescribed anticoagulation medications such as warfarin or dabigatran to prevent blood clots from forming elsewhere in the body.
- Lifestyle changes: Patients are advised to make lifestyle changes such as quitting smoking, eating a healthy diet, and engaging in regular physical activity to reduce their risk of future cardiac events.
- Follow-up care: Patients should attend follow-up appointments with their cardiologist to monitor their progress and assess the function of the stent. They may also undergo regular non-invasive tests such as ECGs, stress tests, and coronary angiograms to monitor the health of their heart.
- Medications: Patients may be prescribed additional medications to manage risk factors such as high blood pressure, high cholesterol, and diabetes, and to reduce the risk of future cardiac events.
The duration of treatment after a PCI for STEMI can vary depending on the patient’s individual circumstances, but typically includes long-term antiplatelet therapy and follow-up care. The goal of treatment is to reduce the risk of recurrent myocardial infarction, heart failure, and other complications, and to improve the patient’s quality of life.
According to the American Heart Association, the prognosis and outcomes for patients with STEMI who receive timely and effective treatment are generally favorable. In the first year after a STEMI, the risk of death is approximately 20%. However, this risk decreases over time, and after five years, the risk of death is similar to that of the general population. The long-term prognosis for patients with STEMI depends on a number of factors, including age, the extent of heart damage, and the presence of underlying medical conditions.
Data from the National Hospital Discharge Survey indicates that the incidence of STEMI in the United States has been decreasing in recent years, due in part to improved treatments and greater awareness of heart disease. In 2017, approximately 250,000 hospitalizations for STEMI were recorded in the United States, representing approximately 1% of all hospitalizations. Among patients who receive PCI for STEMI, approximately 90% experience successful reperfusion of the affected coronary artery, with most patients experiencing significant improvement in their symptoms and quality of life.
It is important to note that the outcomes of STEMI and its treatment can vary widely between individuals, and the information presented here is intended to provide a general overview of the typical treatment and follow-up care for patients with STEMI who have received a stent. Patients should discuss their individual circumstances and prognosis with their cardiologist, and should seek medical attention promptly if they experience any symptoms of a heart attack.