Symptoms Causes of STEMI: Diagnosis, Prevention, and Treatment

Causes of STEMI Symptoms – STEMI is an acute phase of chest pain that lasts a long time and cannot be treated with nitrates. This phase can occur at rest or at any time accompanied by acute myocardial infarction with ST elevation (STEMI) which occurs due to thrombosis resulting from rupture of an unstable atherosclerotic plaque.

According to the American Heart Association (AHA), myocardial infarction remains the leading cause of death and disability worldwide. Every year an estimated 785,000 Americans experience myocardial infarction and around 470,000 people will experience a recurrence, every 25 seconds an estimated 1 American dies due to myocardial infarction (AHA, 2012).

According to the Ministry of Health (Kemenkes), the prevalence of coronary heart disease based on doctor-diagnosed interviews in Indonesia is 0.5%, while based on a doctor’s diagnosis or symptoms of 1.5%. The prevalence of coronary heart disease based on a doctor’s diagnosis was highest in Central Sulawesi (0.8%), followed by North Sulawesi, DKI Jakarta and Aceh with 0.7% each.

Meanwhile, the highest prevalence of coronary heart disease according to diagnosis or symptoms was in East Nusa Tenggara (4.4%), followed by Central Sulawesi (3.8%), South Sulawesi (2.9%), and West Sulawesi (2.6%). . The prevalence of coronary heart disease (CHD) based on doctor-diagnosed interviews or symptoms increases with age, highest in the 65–74 year age group, which is 2.0% and 3.6%, decreases slightly in the age group ≥ 75 years. The prevalence of coronary heart disease diagnosed by a doctor or based on a doctor’s diagnosis or symptoms is higher in women (0.5% and 1.5%).

Definition of STEMI

Segment Elevation Myocardial Infarction (STEMI) is a clinical syndrome that is defined as a typical symptom of myocardial ischemia, which is associated with an ECG picture in the form of persistent ST elevation and followed by the release of biomarkers of myocardial necrosis (Setiati, et al. 2015).

Miocardial infarction (myocardial infarction) is a life-threatening condition with the characteristic sign of permanent muscle necrosis due to loss of oxygen supply to the heart muscle. Myocardial infarction is also known as a heart attack or coronary attack (Udjianti, 2010). Myocardial infarction is the death of myocardial muscle tissue. Myocardial infarction is a total blockage in the coronary arteries (Ruhyanudin, 2007).

STEMI is the acute phase of chest pain which is shown to increase in both frequency and duration of chest pain, and cannot be treated with nitrates, which can occur at rest or at any time accompanied by acute myocardial infarction with ST elevation (STEMI), which occurs due to thrombosis as a result of unstable atherosclerotic plaque rupture (Pusponegoro, 2015).

According to the definition above, it can be concluded that STEMI is a life-threatening condition with typical signs of chest pain associated with an ECG picture in the form of ST elevation and the formation of permanent muscle necrosis tissue occurs because the heart muscle loses its oxygen supply, which is caused by thrombosis as a result of rupture. unstable atherosclerotic plaques.

STEMI symptoms

Blocked heart arteries can cause a number of symptoms. However, these symptoms will vary from person to person. In general, symptoms of STEMI that can appear include:

  • intense chest pain;
  • Chest feels strongly pressed (as if there is a fist in the chest);
  • The pain radiates to the neck, jaw, shoulder and left arm;
  • excessive sweating;
  • Hard to breathe;
  • Indigestion, such as discomfort in the stomach and chest;
  • nausea and vomiting;
  • Fatigue and sudden falls;
  • Palpitations (change in heart rate becomes faster);
  • Headache;
  • Feeling anxious or restless.

If you experience the STEMI symptoms that have been mentioned—especially severe chest pain, immediately consult a doctor to get the appropriate diagnosis and treatment.

Causes of STEMI

The main cause of STEMI is a blockage in the arteries. The blockage occurs totally in the LAD, RCA, or LCX arteries. The blockage is caused by a buildup of plaque in the blood vessels. Plaque is formed from fat and cholesterol contained in the blood. Blood clots can also form when plaque builds up in the arteries. When the arteries are completely blocked, the heart muscle will be damaged and STEMI will occur.

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STEMI Risk Factors

There are a number of factors that increase the risk of this type of heart attack. These factors can actually be controlled to reduce risk, but not all of them. The following are a number of factors that increase the risk of STEMI.

  • Smoking habit;
  • A diet that consumes too much salt, sugar and fat;
  • Lazy to move or never exercise;
  • Excessive alcohol consumption;
  • Use of illegal drugs, such as methamphetamine and cocaine;
  • Aging;
  • Men aged 45 years and over;
  • Women aged 50 years and over or have experienced menopause;
  • Having a family member with a history of a similar disease;
  • Genetics or heredity.

Diagnosis STEMI

Doctors diagnose STEMI based on a physical examination, electrocardiography (ECG) results, and examination of cardiac biomarkers such as a troponin test.

  • Physical examination: evaluate the main symptoms such as chest pain and angina, to accompanying symptoms such as dizziness, shortness of breath and fainting.
  • Electrocardiography (ECG): measures the electrical activity of the heart to detect abnormalities.
  • Troponin test: a biomarker test to confirm a heart attack. Damage to heart cells causes the heart to release a compound called troponin.

If needed, the doctor may also recommend additional examinations.

STEMI complications

STEMI can cause even more severe complications and attack other organs in the body. The following are the types of complications caused by STEMI.

1. Heart Failure

The acute and subacute phases after STEMI are often complicated by myocardial dysfunction. Acute complications that can occur are pump failure with pathological remodeling accompanied by clinical signs and symptoms of heart failure and can end in chronic heart failure.

2. Hypotension

Hypotension due to complications of STEMI is characterized by systolic blood pressure that falls and stays below 90 mmHg. This condition can be caused by heart failure, but can also be due to hypovolemia, rhythm disturbances, or mechanical complications.

3. Lung Congestion

Pulmonary congestion due to complications of STEMI is characterized by wet lung crackles in the basal segments, decreased arterial oxygen saturation, pulmonary congestion on chest X-ray and clinical improvement to diuretics, as well as vasodilator therapy.

4. Arrhythmia

Heart attacks can affect the heart’s electrical system. This condition can cause an irregular heartbeat (arrhythmia). If left alone, arrhythmias can develop into more severe complications. In some cases, this heart disorder also has the potential to result in death.

5. Cardiac arrest

Untreated STEMI has the potential to make the heart stop beating. As a result, blood flow to the brain, organs and limbs is disrupted. Permanent damage to the brain, organs and limbs becomes inevitable.

In severe cases, cardiac arrest has the risk of causing death to those who experience it. The risk of complications can be reduced by getting treatment as early as possible. Therefore, immediately consult a doctor if you experience symptoms of a heart attack.

How to Overcome STEMI

Various ways can be done to overcome this type of heart attack. The doctor may recommend surgery, medication, or a combination of the two. Some of the usual treatment is as follows.

1. Cardiac PCI

Cardiac PCI is a procedure to widen blocked arteries. You do this by inserting a catheter with a balloon into a blood vessel. The balloon is then inflated inside the blocked blood vessel. That way, the size of the arteries becomes wider and blood flow can return smoothly. During this procedure, the doctor may place a stent. These tiny tubes will keep the arteries open and prevent them from getting blocked again.

2. Heart Bypass Surgery

Heart bypass surgery is performed by creating a new path for blood flow near a blocked artery. Generally, these pathways are made using healthy blood vessels or synthetic materials.

3. Administration of Drugs

To treat and prevent a recurrence of a heart attack, a doctor may prescribe some medications. The following types of drugs are commonly given to patients with a history of heart attack.

  • Beta-blockers : relaxes the heart and slows down the heart rate;
  • Statins: lower cholesterol levels in the blood by inhibiting its production in the liver;
  • Antiplatelet: prevent blood clots in the plaque that builds up in the arteries;
  • Pain relief: relieves pain from a heart attack;
  • Nitroglycerin: widens blood vessels so blood can flow again smoothly.
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STEMI Prevention Efforts

STEMI can affect anyone. To reduce the risk of getting this type of heart attack, you should start adopting a healthy lifestyle from now on. Here are some simple steps to prevent it.

  • Maintain an ideal weight;
  • Consumption of balanced nutritious food and reducing sugar, salt and fatty foods;
  • Exercise regularly, at least 30 minutes per day;
  • Not smoking, either actively or passively;
  • Treating factors that can increase the risk.

In addition to the actions above, make sure to always carry out regular health checks. That way, the disease can be detected and treated before it gets worse.

Don’t Delay Medical Help

Every type of heart attack requires medical attention as soon as possible, even if the symptoms don’t really look like problems in the heart. NSTEMI and CAS also require the same treatment, although STEMI is the most dangerous heart attack.

The first treatment that will be given to people who have a heart attack includes:

  • Aspirin to prevent blood clots;
  • Nitroglycerin to relieve chest pain and improve blood flow;
  • Oxygen therapy.

After passing further tests and confirming that you have had a heart attack, you will be given a prescription for more specific treatment or other treatments such as surgery if needed. Some prescription medications are more specific for heart attack sufferers, namely:

  • Clot busters to break up blockages in arteries;
  • Blood pressure regulator drugs to reduce the work of the heart and control blood pressure.
  • Blood thinners to prevent blockages.
  • Statins to lower bad cholesterol (LDL) levels.

Of course, the doctor will provide treatment taking into account a person’s medical history and lifestyle. If all this time his habit is eating carelessly, actively smoking, or being sedentary, that is also included in the doctor’s consideration.

Other Types of Heart Attacks

A heart attack is a form of acute coronary syndrome , which is a condition when the arteries that carry blood, nutrients, and oxygen are blocked. As a result, the heart does not get enough blood and a heart attack occurs.

Some other types of heart attacks, namely:

1. NSTEMI

In contrast to STEMI, an attack of NSTEMI means only partial blockage of the coronary arteries. That’s why when recorded in an electrocardiogram, there is no significant change in the ST segment. However, through coronary angiography it can be seen how large and which part of the blood vessel is blocked.

NSTEMI doesn’t carry the risk of damaging the heart like STEMI, but it’s still a serious condition. The doctor will also do blood tests to see if there are elevated levels of troponin, a protein molecule that is released into the bloodstream when the heart muscle is damaged.

2. Coronary Artery Spasm

Coronary artery spasm is also known as a “silent heart attack” or angina. Sufferers experience blockage of blood vessels due to excess fat deposits, so that blood flow to the heart muscle can be obstructed. Usually, people experience CAS symptoms such as muscle pain or digestive discomfort and don’t think that what is happening includes the symptoms of a heart attack. This happens because one of the heart arteries becomes tighter, so that blood flow is drastically reduced.

Only a medical examination with a doctor can show whether a person has CAS or not. Furthermore, the condition of unstable angina in CAS may not necessarily be relieved by simply resting or taking regular medication. If the blood flow to the heart is not smooth, there can be a lack of oxygen and even death.

Important Things about STEMI

  • Heart attack with a high risk of complications and death.
  • The cause of STEMI is a complete blockage in the LAD, RCA, or LCX arteries.
  • Complications such as arrhythmia, heart failure, and cardiac arrest if not treated immediately.
  • As many as 2.5–10% of sufferers die within 30 days after a heart attack.
  • It can be treated with surgery, medication, or a combination of both.
  • It can be prevented by adopting a healthy lifestyle.

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