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Acute Coronary Syndrome — STEMI

ST-elevation myocardial infarction is a time-critical emergency where rapid reperfusion therapy saves heart muscle and lives.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Acute Coronary Syndrome — STEMI?

Acute coronary syndrome (ACS) describes a spectrum of conditions caused by sudden reduction in coronary blood flow, ranging from unstable angina to non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI).

STEMI is the most severe form, caused by complete thrombotic occlusion of an epicardial coronary artery, leading to transmural ischaemia and irreversible myocyte necrosis if not reperfused promptly.

Diagnosis is made by typical ischaemic symptoms plus persistent ST-segment elevation on ECG (≥1 mm in two contiguous limb leads, ≥2 mm in precordial leads) or new left bundle branch block. Cardiac troponin rises but should not delay reperfusion.

Time is muscle: every minute of ongoing ischaemia leads to further myocardial loss. Door-to-balloon time of ≤90 minutes for primary percutaneous coronary intervention (PCI) is the gold standard.

Symptoms

Crushing, pressure-like or burning retrosternal chest pain lasting >20 minutes
Pain radiating to left arm, neck, jaw, back or epigastrium
Profuse sweating (diaphoresis), nausea and vomiting
Shortness of breath, orthopnoea, anxiety, sense of impending doom
Pallor, cold clammy skin, weak rapid pulse
Hypotension or cardiogenic shock in extensive infarcts
Atypical presentations in elderly, women and diabetics (silent or only dyspnoea)

Risk Factors

Older age (men >45, women >55), male sex, family history of premature CAD
Smoking and chronic exposure to tobacco smoke
Hypertension and untreated high blood pressure
Diabetes mellitus and metabolic syndrome
Dyslipidaemia (high LDL, low HDL, hypertriglyceridaemia)
Obesity, sedentary lifestyle and chronic stress
Cocaine use, severe anaemia and chronic kidney disease

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Call 112 immediately for any chest pain lasting >5 minutes — do not drive yourself
  • Chew 300 mg uncoated aspirin while waiting for the ambulance unless contraindicated
  • Sublingual nitroglycerin may be used if systolic blood pressure >90 mmHg
  • Patients with known stents or prior MI must seek emergency care for any new chest pain
  • Cardiac arrest requires immediate CPR and defibrillation

Treatment Methods

01
Primary PCI within 90 minutes of first medical contact (preferred reperfusion strategy)
02
Fibrinolytic therapy (tenecteplase, alteplase) within 30 minutes if PCI not available within 120 minutes
03
Dual antiplatelet therapy: aspirin 300 mg + ticagrelor 180 mg or prasugrel 60 mg loading dose
04
Anticoagulation with unfractionated heparin or enoxaparin
05
High-intensity statin (atorvastatin 80 mg) initiated immediately
06
Beta-blocker, ACE inhibitor and aldosterone antagonist titration in stable patients
07
Cardiac rehabilitation, smoking cessation and aggressive secondary prevention

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.