NSTEMIn

NSTEMIn is commonly used to refer to non-ST-elevation myocardial infarction, though the standard acronym is NSTEMI. NSTEMI is a type of acute coronary syndrome in which myocardial necrosis occurs due to reduced blood flow to part of the heart. Unlike ST-elevation myocardial infarction (STEMI), NSTEMI does not show persistent ST-segment elevation on a standard electrocardiogram.

Pathophysiology: It typically results from plaque rupture with superimposed partial thrombosis causing partial occlusion of a coronary artery. Reduced blood flow leads to myocardial ischemia and eventual cell injury or death, with troponin release into the blood. NSTEMI may be distinguished from unstable angina by the presence of elevated cardiac troponin.

Clinical features and diagnosis: Patients often report chest discomfort or pressure, shortness of breath, sweating, or nausea. Symptoms can be similar to other cardiac or non-cardiac conditions. Diagnosis relies on serial ECGs (which may show ST-segment depression or T-wave inversion) and rising or falling troponin levels. Imaging tests, such as echocardiography or coronary angiography, help assess extent of ischemia and guide treatment.

Management: Initial care includes antiplatelet therapy (commonly aspirin plus a P2Y12 inhibitor such as clopidogrel, ticagrelor, or prasugrel) and anticoagulation. Nitrates and beta-blockers are used for symptom relief and to reduce myocardial oxygen demand; high-intensity statin therapy is started or intensified. Risk stratification using scores like TIMI or GRACE guides timing of invasive management. Most patients undergo coronary angiography with possible revascularization (percutaneous coronary intervention or coronary artery bypass grafting) within 24 to 72 hours, or sooner in high-risk cases.

Prognosis: With timely recognition and guideline-directed therapy, short-term mortality is reduced. Long-term outcomes depend on prompt treatment, risk factor control, and adherence to secondary prevention strategies such as antiplatelet therapy, lipid management, blood pressure control, smoking cessation, and lifestyle modification.