NSTEMIhoito

NSTEMIhoito refers to the medical management of non-ST-elevation myocardial infarction, a type of heart attack caused by reduced blood flow due to a partial blockage of a coronary artery. Unlike STEMI, NSTEMI does not show persistent ST-segment elevation on the ECG, but troponin levels are elevated, indicating myocardial injury. Diagnosis relies on clinical symptoms, ECG findings, and biomarkers, and risk stratification guides the treatment approach.

Initial management occurs in hospital and focuses on relieving ischemia, limiting myocardial damage, and preventing complications. All eligible patients are given aspirin as soon as feasible. A P2Y12 receptor inhibitor (such as clopidogrel, ticagrelor, or prasugrel) is added based on risk and bleeding considerations. Anticoagulation with agents like heparin or enoxaparin is commonly used. Nitrates relieve chest pain, and beta-blockers are typically started unless contraindicated. High-intensity statin therapy is recommended. Oxygen is reserved for patients with hypoxemia. ACE inhibitors or ARBs are considered for patients with heart failure, hypertension, diabetes, or reduced ejection fraction.

Invasive strategy decisions are guided by risk assessment. Many patients undergo coronary angiography with a view to revascularization (percutaneous coronary intervention or, less commonly, coronary artery bypass grafting) within 24 to 48 hours for higher-risk cases; stable patients may be managed conservatively with close monitoring. Glycoprotein IIb/IIIa inhibitors are used in selected high-risk procedures. Dual antiplatelet therapy is typically continued for several months after a stent, with long-term aspirin and tailoring to bleeding risk.

Secondary prevention includes risk-factor modification, smoking cessation, optimal blood pressure and glucose control, lipid management with statins, and participation in cardiac rehabilitation.