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What is NSTEMI: Symptoms, Causes & Treatment

Sandeep Dhanyamraju MD
Medically reviewed by Sandeep Dhanyamraju
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Sandeep Dhanyamraju MD
Medically reviewed by Sandeep Dhanyamraju

The heart is a vital organ that is often exposed to danger. Attacks are fraught with severe consequences for the entire body. Non-st elevation myocardial infarction (NSTEMI) requires urgent medical attention. Otherwise, death is possible. 

Understanding what NSTEMI is and what you need to do next is essential. This cardiac event differs from others in its symptoms and treatment methods. Studying the causes and clinical picture is vital because you can provide the person with timely help. Individuals can recognize the signs of such heart attack. Also, they need to know how to provide first aid.

Exploring treatment options ranging from medications to invasive procedures like angioplasty. It offers insights into managing NSTEMI and mitigating its potential complications. Through comprehensive knowledge of this condition, individuals can take proactive steps. 

What is NSTEMI?


NSTEMI is a medical abbreviation used to describe a type of heart attack. STEMI (ST-Elevation Myocardial Infarction) involves complete blockage of a coronary artery. NSTEMI occurs when partial blockage or reduced blood flow to the heart muscle. This condition is typically diagnosed based on clinical signs and electrocardiogram (ECG) findings. Also, doctors analyze cardiac biomarker levels. Prompt medical intervention is crucial to prevent further damage to the heart and improve outcomes. Understanding what NSTEMI is is vital. Here are key points to consider:

  • Clinical Presentation: Such cardiac event presents with several signs. Among them are chest pain or discomfort, shortness of breath, nausea, and fatigue. They are similar to other types of heart attacks.
  • Diagnostic Criteria: Diagnosing NSTEMI is generally based on clinical evaluation and ECG findings. Also, it depends on cardiac biomarker levels, such as troponin.
  • Risk Factors: They include age, hypertension, diabetes, smoking, and high cholesterol. Also, among the risk factors are obesity and a sedentary lifestyle.
  • Complications: NSTEMI heart attack can lead to heart failure, arrhythmias, and cardiogenic shock. Also, it may even cause death if not treated promptly.
  • Treatment: The healing plan involves antiplatelet agents, anticoagulants, beta-blockers, and statins. They help to prevent further clot formation and reduce the risk of recurrent events. Invasive procedures may restore blood flow to the affected artery. Among them are coronary angiography and percutaneous coronary intervention (PCI).

These are all significant factors that go into detecting and treating the problem. It’s all worth looking at in more detail to know how to react quickly.

Understanding this cardiac event is essential for timely recognition, intervention, and management. Underlying the causes and signs and using appropriate treatment strategies are vital. So, healthcare professionals can improve outcomes and reduce mortality associated with NSTEMI.


It is important to note that NSTEMI ECG findings should be consistently interpreted with several factors. These are clinical symptoms, cardiac enzyme levels, and other diagnostic tests. They are necessary for a comprehensive assessment of myocardial infarction. The findings typically include:

  • ST-Segment Depression: This is a critical finding in NSTEMI. There, the ST segment is generally depressed compared to the initial level.
  • T-Wave Inversions: T-wave inversions may be present, indicating myocardial ischemia or injury.
  • Dynamic Changes: ECG findings in NSTEMI can be dynamic, meaning they may evolve.
  • ST-Segment Elevation: ST-segment elevation is not typically present in NSTEMI. It may occur transiently or in specific leads. ST-segment indicates a more severe ischemic event or progression to STEMI.
  • Other Signs of Ischemia: These can include the presence of Q waves, although these are usually not as prominent as in STEMI.
  • Bundle Branch Block: This may complicate the interpretation of ECG findings in NSTEMI.

Prompt recognition and treatment of NSTEMI are crucial. It helps to prevent further cardiac damage and improve patient outcomes.

Common Causes of NSTEMI

Such a cardiac event occurs when blood flow to a part of the heart is significantly reduced or blocked. It leads to the spread of the disease. Unfortunately, doctors are still researching to learn more about the causes of this disease. However, the three most widespread causes of NSTEMI are already known. Therefore, let’s look at these causes for early recognition and intervention. It is crucial for the treatment of this acute coronary syndrome.

Coronary Artery Disease (CAD)

This common condition is always characterized by plaque buildup within the coronary arteries. It supplies oxygen-rich blood to the heart muscle. The buildup of plaque, cholesterol, calcium, and other substances narrows the arteries. It reduces blood flow to the heart. CAD can lead to various complications: 

  • angina (chest pain or discomfort)
  • myocardial infarction (heart attack)
  • heart failure

It’s also worth looking at some common risk factors for CAD development. These include:

  • high blood pressure
  • high cholesterol
  • smoking
  • diabetes
  • obesity
  • sedentary lifestyle
  • family history of heart disease

Management of CAD typically involves lifestyle modifications (such as exercise and a healthy diet). Also, it includes statins, antiplatelet drugs, and, in some cases, procedures. Among them are angioplasty or coronary artery bypass surgery. 

Plaque Rupture

This NSTEMI cause is a significant mechanism underlying its development. In individuals with CAD, atherosclerotic plaques can become unstable and vulnerable to rupture. When a plaque ruptures, it exposes the underlying thrombogenic material. It triggers the formation of a blood clot (thrombus) within the coronary artery. This thrombus can wholly or partially obstruct the artery, reducing blood flow to the myocardium. The reduction in blood flow results in myocardial ischemia. It manifests as chest pain or discomfort. If the ischemia is generally prolonged, it can cause myocardial cell death, resulting in NSTEMI. Prompt recognition and treatment of plaque rupture are crucial. It helps to minimize myocardial damage and improve patient outcomes in NSTEMI cases.

Coronary Vasospasm

Such a condition refers to the sudden constriction or narrowing of the coronary arteries. It leads to a temporary reduction or cessation of blood flow to the heart muscle. This condition is also known as Prinzmetal’s angina or variant angina. It can occur spontaneously or be usually triggered by stress, cold temperatures, or certain medications. The affected coronary artery experiences intense, abnormal contraction during a coronary vasospasm. It causes chest pain or discomfort (angina). In severe cases, this spasm can lead to myocardial ischemia and potentially result in serious cardiac events. Among them are unstable angina or even an NSTEMI heart attack. Treatment may involve medications to relax the coronary arteries (vasodilators) and lifestyle modifications. It helps to reduce triggers and risk factors. Early recognition and management are essential to prevent complications.

Recognizing NSTEMI Symptoms


Recognizing the typical signs is crucial for timely medical intervention and management. Unlike the classic presentation of STEMI, it may present subtler ones. They can be easily overlooked. However, prompt recognition is essential as NSTEMI carries a significant risk of complications. Understanding the ordinary symptoms of NSTEMI is vital. It can help individuals and healthcare professionals alike to initiate appropriate diagnostic evaluation. Also, it is crucial for cogitation treatment strategies to improve patient outcomes.

Chest Discomfort

Such a hallmark sign of non-ST elevation myocardial infarction. Chest discomfort should be seriously taken. It typically presents as a sensation of pressure, squeezing, fullness, or pain in the center of the chest. The discomfort may persist for a few minutes or come and go. Individuals experiencing it may also describe it as tightness or heaviness in the chest. While chest discomfort is the most common sign of NSTEMI, it’s essential to note that not everyone experiences it similarly. Some individuals may only feel mild discomfort or may mistake it for indigestion. Any similar manifestation of non-ST elevation myocardial infarction warrants immediate medical attention.

Pain or Discomfort in Other Areas of the Upper Body

This sign refers to sensations of pressure, squeezing, or pain that extend beyond the chest. It may manifest in:

  • arms (usually the left arm but can also affect the right arm)
  • back
  • neck
  • jaw
  • stomach

This manifestation is often described as radiating or spreading from the chest. It is characteristic of a myocardial infarction, such as NSTEMI. It occurs when partial or temporary coronary artery blockage reduces blood flow to the heart muscle. Recognizing these additional areas of discomfort alongside chest pain or pressure can be crucial. It helps identify a potential cardiac event and seek prompt medical attention. This aims to prevent further complications.

Shortness of Breath

Itis a significant symptom of NSTEMI, indicating potential cardiac involvement. This sign can manifest as difficulty breathing or a sensation of breathlessness. It often accompanies chest discomfort or occurs independently. In NSTEMI, shortness of breath may result from reduced oxygen supply to the heart muscle. It is leading to cardiac dysfunction or heart failure. It can occur suddenly or gradually and may worsen with exertion or lying flat. People who experience shortness of breath should seek medical attention immediately. Shortness of breath can have various causes. They include respiratory conditions. Considering NSTEMI as a possible underlying cause is crucial. It is especially vital when accompanied by other cardiac signs. Among them are chest pain or discomfort.

Effective Treatment for NSTEMI

Treatment for NSTEMI aims to restore blood flow to the heart, alleviate signs, and prevent complications. Also, it helps to reduce the risk of future cardiovascular events. A healing plan for this condition usually involves a combination of drug therapy and invasive procedures. Also, it includes lifestyle changes.

Treatment Modality Description
Medications Antiplatelet Therapy: Aspirin and P2Y12 inhibitors (e.g., clopidogrel, ticagrelor). They help to prevent further blood clot formation. Also, it aims to reduce the risk of recurrent events. 

Anticoagulant Therapy: Heparin, enoxaparin, or fondaparinux to prevent blood clots. Also, they help to decrease the risk of blood clots growing.

Beta-Blockers: To reduce heart rate, blood pressure, and myocardial oxygen demand. 

ACE Inhibitors or ARBs: To improve cardiac function and reduce ventricular remodeling. Also, they help to lower blood pressure.

Statins: To lower cholesterol levels and stabilize atherosclerotic plaques. 

Analgesics: To relieve chest pain or discomfort.

Invasive Procedures Coronary Angiography: To visualize the coronary arteries and identify blockages or narrowing. 

Percutaneous Coronary Intervention (PCI): It includes balloon angioplasty and stent placement. It helps to open blocked arteries and restore blood flow. 

Coronary Artery Bypass Grafting (CABG): In multivessel disease cases, bypass surgery is necessary. It may be generally considered to reroute blood flow around blocked arteries.

Revascularization Strategies Early Invasive Strategy: Immediate coronary angiography and revascularization within 24 to 72 hours. This is especially true for high-risk patients with ongoing ischemia and hemodynamic instability. 

Selective Invasive Strategy: Intended for low-risk patients with contraindications to invasive procedures. Angiography and revascularization are generally performed only in case of recurrent ischemia.

Lifestyle Modifications Smoking Cessation: Quitting smoking reduces the risk of further cardiovascular events. 

Healthy Diet: Focus on a diet rich in fruits, vegetables, whole grains, and lean proteins. At the same time, limit saturated fat, cholesterol, and sodium.

Regular Exercise: Regular physical activity improves cardiovascular health and overall well-being. 

Weight Management: Achieving and maintaining a healthy weight reduces the strain on the heart. Also, it lowers cardiovascular risk factors. 

Stress Reduction: Manage stress through relaxation techniques, meditation, or counseling. This may benefit heart health.

Cardiac Rehabilitation A structured exercise and education program designed to improve cardiovascular health. This helps optimize drug therapy and support lifestyle changes.

Effective treatment for NSTEMI involves a multidisciplinary approach. It collaborates closely with cardiologists, emergency physicians, nurses, and other healthcare professionals. Early recognition, timely intervention, and comprehensive secondary prevention strategies are essential. It helps to improve outcomes and reduce the risk of recurrent events. Starting the right therapy early will help achieve results.


So, what is NSTEMI? This is a type of heart attack that manifests itself with several characteristic symptoms. It is essential to recognize this condition in time to take the necessary measures. In our article, we analyze the clinical picture and common causes. We also delved into the treatment method, which involves an integrated approach. For comprehensive cardiac care, trust our Neurological Center Lone Star. We’ll provide you with expert evaluation and management.


What are the first signs of an NSTEMI heart attack?

The first signs typically include chest discomfort, shortness of breath, nausea, and lightheadedness.

How is NSTEMI different from a typical heart attack?

NSTEMI differs from a STEMI in that there is no significant ST segment elevation on the electrocardiogram (ECG). The degree of myocardial damage may be less severe.

Can NSTEMI be treated successfully?

NSTEMI can be successfully treated with medications, invasive procedures, and lifestyle modifications. 

What are the leading causes of NSTEMI?

The leading causes of NSTEMI include coronary artery disease (atherosclerosis) and coronary vasospasm.

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Edward Medina
Edward Medina
15:34 30 Jun 22
Just such an amazing staff that makes you feel like part of their family. I’ve been going there for over 5 years now... and each visit I get the very best care and treatments that I have ever received in the 20+ years that I’ve been dealing with severe debilitating migraines. Since i started seeing them the number of my migraines has dropped from 15-20 a month to 2-3 every 3 month. I highly recommend them …they will change your life!read more
Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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