STEMI: The Most Severe Type of Heart Attack (2023)

An ST elevation myocardial infarction (STEMI) is a heart attack that occurs when a major artery feeding into the heart is completely blocked, changing blood flow to the organ and the electrical current in the lower chambers.

A STEMI is the most serious and deadly type of heart attack. Between 4% and 24% of those hospitalized for one die from the condition.

STEMI symptoms may include upper body pain and discomfort, as well as exhaustion and nausea. Treatment will vary, but may include drugs that stabilize the heart or reduce blood clots, oxygen therapy, or procedures, such as an angioplasty or stenting.

This article explains what a STEMI heart attack is. It also covers symptoms, diagnosis, and treatment options.

The Heart: Anatomy, Function, and Conditions

What Is a STEMI Heart Attack?

STEMI is the most severe type of acute coronary syndrome (ACS), which describes conditions where there is a rapid decrease of blood flow to the heart.

STEMI pathophysiology, or how one comes about, is as follows:

  • A fatty substance called plaque builds up in the coronary arteries, which supply blood to the heart.
  • This stress triggers a tear in the artery, which blood clots, or clumps of blood, cover up.
  • This causes a complete blockage in the artery.
  • When blocked, the part of the heart muscle serviced by that artery will quickly suffer from a lack of oxygen, also called ischemia.
  • Some of the heart muscle will begin to die resulting in a myocardial infarction, or heart attack.

STEMI vs. NSTEMI vs. Unstable Angina

Other, less severe, types of ACS are notably different from the STEMI type. They include:

  • Unstable angina: With this type of ACS, blood clots will form, dissolve, and re-form without causing a fixed blockage. When this happens, an individual may have random chest pain, even when resting.
  • Non-ST-segment elevation myocardial infarction (NSTEMI): This occurs when the blockage doesn't completely stop the blood flow in a major artery or totally blocks a minor artery. It may be called a "partial heart attack."

STEMI: The Most Severe Type of Heart Attack (1)

Why It's Called a STEMI Heart Attack

A STEMI is so-named because it causes an increase in the ST segment of an electrocardiogram (ECG)—a diagnostic test that uses sensors to monitor the heart's electrical activity and records it on a line graph.

The ST segment refers to a part of the test that shows the heart's activity in a wave pattern. When a person has the most severe type of heart attack, this segment will appear abnormally elevated, instead of flat. This indicates a total blockage.

Symptoms of a STEMI Heart Attack

Symptoms can vary from person to person. Some STEMI symptoms may include:

  • Pain around theshoulder blades, arm, chest, jaw, left arm, or upper stomach
  • Pain or pressure around chest area, also known as angina
  • Sweating, or feeling out of breath
  • Discomfort or tightness in the neck or arm
  • Indigestion, which is discomfort in the stomach and chest
  • Heartburn, which describes when you have an acidic taste in your mouth and upper chest discomfort
  • Nausea and vomiting
  • Fatigue or sudden exhaustion
  • Dizziness
  • Increased or irregular heart rate

Anyone who is at risk of a heart attack should pay close attention to any unusual symptoms and seek medical attention right away if any are noticed.

STEMI: The Most Severe Type of Heart Attack (2)

How STEMI Is Diagnosed

To diagnose a STEMI, a healthcare provider will go over your symptoms. They will also run diagnostic tests like an ECG, or magnetic resonance imaging (MRI), which creates a detailed image of your heart. In addition, your healthcare provider may also run blood tests, known as cardiac biomarkers, to check for heart muscle damage.

(Video) Acute Coronary Syndrome: Unstable Angina, NSTEMI and STEMI (Heart Attack), Animation

How a Heart Attack Is Diagnosed

STEMI Treatment

Because a STEMI is a severe heart attack, treatment will begin as soon as possible. Keep in mind, the longer it takes to unblock the artery, the more damage there may be.

STEMI treatment may include:

  • Drugs that help stabilize the heart and reduce pain like morphine, beta-blockers, and statin medications
  • Oxygen therapy to increase the oxygen sent to your tissues
  • Medication, like aspirin, that helps stop blood clots
  • An angioplasty, a minimally invasive surgery that repairs the impacted artery
  • Stenting, which involves the insertion of a mesh tube to reopen the blocked artery

After treatment, the recovery period begins. This may include an exercise-based rehabilitation program, dietary changes, and the use of medications like blood thinners, which prevent blood clots.

STEMI Heart Attack Prognosis

STEMI is the most deadly type of heart attack. Mortality rates, or the amount of people who die due to this type of heart attack, differ by the location of the blockage, as well as other factors, such as age, sex, risk factors, and medical history.

In general, the hospital mortality rate for:

  • A STEMI ranges from 4% to 24%
  • An anterior STEMI is 21.4%
  • An inferior localized STEMI is 12.2%

Keep in mind that this number can rise to about 38% if an individual experiences a complication, like sudden cardiac arrest, before making it to the hospital.

Other factors that increase the risk of death from STEMI include history of:

  • A prior heart attack
  • Hypertension
  • High cholesterol
  • Diabetes
  • Heart failure
  • Smoking

In addition, the older a person is, the more likely STEMI will be fatal. Research shows people age 80 and older have a 45.9% mortality rate from STEMI.

How Long Can You Live After a STEMI Heart Attack?

Individuals who survive past the year mark have a life expectancy similar to that of the general population.

How Do You Avoid a STEMI Heart Attack?

While you can't control all factors that help prevent a STEMI heart attack, there are some things you can do to reduce your risk, including:

  • Maintaining a healthy weight
  • Getting regular exercise
  • Decreasing alcohol intake
  • Quitting smoking
  • Reducing stress
  • Managing cholesterol, blood pressure, and diabetes

Causes and Risk Factors of Heart Disease

(Video) Dangers of a STEMI Heart Attack

Summary

STEMI is the most severe type of acute coronary syndrome. With this type of heart attack, there is a complete blockage in one of the coronary arteries.

Symptoms of a STEMI may vary from person to person, but generally include discomfort, pain, or pressure around the chest area.

To diagnose a STEMI, your healthcare provider will go over your symptoms, as well as run various diagnostic tests. Treatment will begin as soon as possible and may include various medications and procedures to help unblock the artery and reduce discomfort.

Frequently Asked Questions

  • Can stress cause a STEMI heart attack?

    Long-term stress is not a direct cause of a STEMI heart attack, but it is linked to an increased risk of one or other cardiovascular disease events.

  • How long does it take to recover from a STEMI heart attack?

    In general, recovery from a STEMI will take several months. Cardiac rehabilitation and exercise will play a key role during this time.

8 Sources

(Video) STEMI Heart Attack

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. MedlinePlus. Acute coronary syndrome.

  2. MedlinePlus. Unstable angina.

  3. Vasiljević Z, Stojanović B, Kocev N, et al. [Hospital mortality trend analysis of patients with ST elevation myocardial infarction in the Belgrade area coronary care units]. Srp Arh Celok Lek. 2008;136 Suppl 2:84-96. Serbian. doi:10.2298/sarh08s2084v

  4. Karam N, Bataille S, Marijon E, et al. Incidence, mortality, and outcome-predictors of sudden cardiac arrest complicating myocardial infarction prior to hospital admission.Circulation: Cardiovascular Interventions. 2019;12(1):e007081. doi:10.1161/CIRCINTERVENTIONS.118.007081

  5. Pascual I, Hernandez-Vaquero D, Almendarez M, et al. Observed and expected survival in men and women after suffering a stemi.J Clin Med. 2020;9(4):E1174. doi:10.3390/jcm9041174

  6. American Heart Association. Lifestyle changes for heart attack prevention.

  7. Tawakol A, Ishai A, Takx RA, et al. Relation between resting amygdalar activity and cardiovascular events: a longitudinal and cohort study.The Lancet. 2017;389(10071):834-845. doi:10.1016/S0140-6736(16)31714-7

  8. The Texas Heart Institute. Recovering From a Heart Attack.

STEMI: The Most Severe Type of Heart Attack (3)

By Richard N. Fogoros, MD
Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology.

(Video) What is a STEMI heart attack?

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FAQs

Is a STEMI a massive heart attack? ›

A STEMI is a very serious heart attack where one of the heart's major arteries is blocked. It can be a life-threatening event. From your arrival at the hospital until the heart's blocked artery is opened should be just 90 minutes, so the entire cardiac team must work together very quickly.

Which is more severe STEMI or NSTEMI? ›

An NSTEMI is a less severe form of heart attack than the STEMI because it inflicts less damage to the heart. However, both are heart attacks and require immediate medical care.

Why is STEMI more serious? ›

That's dangerous because the ventricles are the chambers of your heart that pump blood to your lungs and body. If there's too much damage to the muscle in the ventricles, your heart can't pump enough blood to support your body. That's why STEMIs are so dangerous and why restoring blood flow quickly is so critical.

How serious is STEMI? ›

The most deadly type of heart attack is the ST-elevated myocardial infarction (STEMI). STEMI is a total or nearly total blockage of a coronary artery that supplies oxygen-rich blood to part of the heart muscle. Lack of blood and oxygen causes that part of the heart to fail.

Can you survive STEMI? ›

In-hospital mortality of unselected patients with STEMI ranges from 4 to 12%.

Is a STEMI heart attack a Widowmaker? ›

All heart attacks are serious, but one type of is the most dangerous of all and it's known as a STEMI (ST segment elevation myocardial infarction), or a widowmaker heart attack.

What is the main difference between STEMI and NSTEMI? ›

STEMI results from complete and prolonged occlusion of an epicardial coronary blood vessel and is defined based on ECG criteria..NSTEMI usually results from severe coronary artery narrowing, transient occlusion, or microembolization of thrombus and/or atheromatous material.

Why are STEMI and NSTEMI treated differently? ›

Equally important, NSTEMI heart attacks are caused by different types of blood clots than STEMI heart attacks, with differing amounts of clotting proteins and platelet blood cells. Therefore, the treatment of NSTEMI heart attacks differs from the treatment of STEMI heart attacks.

What is the most common STEMI? ›

Most patients with ST-segment elevation MI (STEMI) and many with non-ST-segment elevation MI (NSTEMI) comprise this category. Type 2 MI is the most common type of MI encountered in clinical settings in which is there is demand-supply mismatch resulting in myocardial ischemia.

What is the main cause of a STEMI? ›

STEMI causes can include: Buildup of plaque – fat, cholesterol and other cellular waste – on artery walls. Drugs, including cocaine and excessive alcohol. Smoking.

What happens to the heart during STEMI? ›

An STEMI is the most serious type of heart attack where there is a long interruption to the blood supply. This is caused by a total blockage of the coronary artery, which can cause extensive damage to a large area of the heart. An STEMI is what most people think of when they hear the term "heart attack".

What is a STEMI caused by? ›

STEMI: Most commonly caused by an acute occlusion of a coronary blood vessel secondary to acute plaque rupture and thrombosis. However, cocaine use can also cause a STEMI due to coronary vasospasm, rather than occlusion with thrombosis.

Can a STEMI cause heart failure? ›

We observed 12 (0.9%) patients developed HF within 7 days from index STEMI. The crude incidence rate of HF following a first STEMI was 9.7 (95% CI 7.7 to 11.8) per 1000 person-years.

Is STEMI a stroke? ›

Conclusions. In patients presenting with STEMI, the risk of stroke is low (0.76%). A stroke in patients presenting with STEMI is associated with significantly higher in‐hospital (18%) and long‐term mortality (35% at 5 years). Stroke was associated with double the risk of 5‐year death.

Is STEMI reversible? ›

Acute Microvascular Impairment Post-Reperfused STEMI Is Reversible and Has Additional Clinical Predictive Value - PMC.

How long do you stay in hospital after STEMI? ›

Uncomplicated STEMI patients with single vessel disease could be discharged after 24 hours. Patients with multi-vessel disease classified in the low risk group could be discharged after 48 hours.

Can you stent a STEMI? ›

Primary percutaneous coronary intervention (PCI) with stent implantation has been the standard therapy in acute STEMI patients. Compared with medical treatment alone, stent implanting can achieve larger lumen gain and helps to reduce the re-occlusion risk of the infarct-related artery (IRA).

Why is a heart attack called a STEMI? ›

A heart attack with a completely blocked coronary artery is called a STEMI. STEMI stands for ST Elevation Myocardial Infarction. On a heart tracing there is a particular area that is called the ST segment. When this segment is elevated, the person is said to have a STEMI.

Is STEMI an emergency? ›

ST-segment myocardial infarction (STEMI) is a time-sensitive emergency that requires swift and seamless integration of prehospital and emergency department resources in order to achieve early diagnosis and reperfusion therapy.

Can a NSTEMI be fatal? ›

The damage to the heart from an NSTEMI is less serious than that of a STEMI. However, any heart attack can be very frightening. NSTEMI and STEMI heart attacks can be fatal and cause lasting damage to the organ and increase the risk of subsequent heart problems.

Is STEMI same as acute MI? ›

Acute MI includes both non-ST-segment-elevation myocardial infarction (NSTEMI) and ST-segment-elevation myocardial infarction (STEMI). Distinction between NSTEMI and STEMI is vital as treatment strategies are different for these two entities.

Can an NSTEMI turn into a STEMI? ›

Even so, if NSTEMI involves the partial blockage of a major coronary artery, it can progress to STEMI within hours, weeks, or months if not properly treated.

What is the best treatment for STEMI? ›

Primary percutaneous coronary intervention (PCI) is the term for emergency treatment of an STEMI. It's a procedure to widen the coronary artery (coronary angioplasty). Coronary angiography is done first, to assess your suitability for PCI.

What is the first line treatment for STEMI? ›

INITIAL MANAGEMENT — The initial management of patients with STEMI requires rapid selection and administration of reperfusion therapy. Patients with STEMI should also receive treatments that prevent further coronary artery thrombosis, minimize myocardial injury, and treat the symptoms of MI.

What is the best emergency treatment for STEMI? ›

This protocol recommends empiric treatment of patients with suspected STEMI with morphine, oxygen, nitroglycerin, and aspirin. Specific prehospital care includes the following: Intravenous access, supplemental oxygen, pulse oximetry. Immediate administration of aspirin en route.

Does a STEMI require surgery? ›

STEMI can be treated with “clot-busting” drugs called thrombolytics (also called fibrinolytics) or with a primary percutaneous coronary intervention (PCI) in a cardiac catheterization lab. This procedure is also referred to as angioplasty or stenting.

What is considered a massive heart attack? ›

A STEMI heart attack is known as a “classic” or massive heart attack. But what is a STEMI heart attack exactly? STEMI stands for ST-elevation myocardial infarction. This type of heart attack is caused by a complete blockage in one of the coronary arteries supplying blood to the heart muscle.

What type of heart attack is a STEMI? ›

A heart attack with a completely blocked coronary artery is called a STEMI. STEMI stands for ST Elevation Myocardial Infarction. On a heart tracing there is a particular area that is called the ST segment. When this segment is elevated, the person is said to have a STEMI.

How long does it take to recover from a STEMI heart attack? ›

Recovery from a heart attack (myocardial infarction) can take anywhere from two weeks to three months. When you're fully recovered, you'll be able to return to work and your normal routine.

Why is STEMI worse than Nstemi? ›

STEMI vs NSTEMI – Which is Worse? The bottom line is that both are just as bad. STEMI is seen as more of an immediate emergency because there is a known total occlusion of a heart vessel that needs opening back up urgently. In terms of long-term outcomes, they have equal health implications.

What is the most serious danger of a heart attack? ›

If you've had a heart attack, your heart may be damaged. This could affect your heart's rhythm and its ability to pump blood to the rest of the body. You may also be at risk for another heart attack or conditions such as stroke, kidney disorders, and peripheral arterial disease (PAD).

What are the three types of heart attacks? ›

The three types of heart attacks are: ST segment elevation myocardial infarction (STEMI) non-ST segment elevation myocardial infarction (NSTEMI) coronary spasm, or unstable angina.

What is the difference between a STEMI and non STEMI heart attack? ›

STEMI results from complete and prolonged occlusion of an epicardial coronary blood vessel and is defined based on ECG criteria..NSTEMI usually results from severe coronary artery narrowing, transient occlusion, or microembolization of thrombus and/or atheromatous material.

What causes STEMI heart attack? ›

STEMI Myocardial Infarction Causes

Drugs, including cocaine and excessive alcohol. Smoking. High blood pressure. High cholesterol.

How do you classify STEMI? ›

If a patient with such ECG changes develops myocardial infarction (defined by elevated troponin levels in blood), the condition is classified as STEMI (ST Elevation Myocardial Infarction). STEMI is only diagnosed when elevated troponin levels have been confirmed; until then, the condition is classified as STE-ACS.

Can stress cause a STEMI heart attack? ›

Overall, mental stress-induced myocardial ischemia occurred in 16% of patients and conventional ischemia in 35%, suggesting that traditional ischemia due to exercise- or drug-induced stress is more common. Over a three-year follow-up, 10% of patients (n=28) had another MI and two died of heart-related problems.

Is a STEMI reversible? ›

Acute Microvascular Impairment Post-Reperfused STEMI Is Reversible and Has Additional Clinical Predictive Value - PMC.

What is the most common cause of out of hospital death from STEMI? ›

More than 1 of 20 STEMI patients present prehospital sudden cardiac arrest after emergency medical services arrival, leading to a 10-fold higher mortality at hospital discharge compared to STEMI without sudden cardiac arrest.

What is the primary cause of in hospital death due to STEMI? ›

Coronary heart disease remains the leading cause of mortality [1]. Prevention of in-hospital death is a crucial step in improving prognosis of patients with ST elevation myocardial infarction (STEMI).

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