Myocardial Infarction (MI): STEMI vs. NSTEMI (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 How do we classify MI so that's another way of saying how bad is it? Well number one shows you a sub endocardial infarction.

    00:10 That's a non-STEMI is what it would look like on an EKG.

    00:14 So non-STEMI, that's a non-st segment elevation MI.

    00:19 Now look where it is.

    00:20 It's kind of the farthest in the deepest to the tissue, but it's just sub endocardial.

    00:26 The second one I want to talk to you about is an intramural infarction.

    00:31 Now this is also an NSTEMI but look where it's located in the drawing kind of right in the center, right? It's not sub into cardio, It's not external.

    00:39 It's right there in the middle.

    00:41 That's an intramural infarction.

    00:44 Now number three shows you a transmural infarction this one is the most serious has the highest risk of complications.

    00:52 That is a STEMI an ST segment elevation MI and you'll see it goes all the way through.

    01:00 So you may hear hear people refer to it as a transmural infarction or a STEMI same thing.

    01:05 We've got this picture here to help you understand how these all interact.

    01:10 Now number four is another non-STEMI.

    01:13 So 1, 2 and 4 are non-STEMI's.

    01:16 This is a sub epicardial infarction.

    01:19 And you see where it's located.

    01:21 Okay, this is another slide that is worth your time coming back spending review with it because you'll hear these words used in real practice all the time, and it will be fast when it comes out.

    01:33 So you want to make sure that when you hear these terms you can picture in your mind what this is and give you a feel for severe how the patient's damages to the heart wall.

    01:43 Number three is the side but big winner as having the most serious complications.

    01:49 So we talked about non-STEMI and STEMI.

    01:52 Let's look at it one more time just to make sure it's clear for you NSTEMI is a non-st elevation myocardial infarction.

    01:59 You'll see some ST segment depression on EKG.

    02:02 But keep in mind ST segment depression can also be caused by reversible myocardial ischemia.

    02:10 The stemi is the ST segment elevation.

    02:13 So that's what I will see on an EKG.

    02:16 I'll see the portion of the EKG that represents the ST segment will be elevated.

    02:21 This is a bad deal.

    02:23 So you see that ST segment elevation on an EKG.

    02:27 We know this patient is more likely to experience more significant damage and have a worse prognosis than if they'd had a non-STEMI.

    02:37 Now here's that ST segment we keep talking about just a review for you if you're a little bit unfamiliar with this or need a refresher, you can see that we've used colors on this slide and they're really helpful, because the first color shows you where the p waves starts and ends the next one shows you the pr segment, he gray one the QRS segment talking about the ventricle.

    03:01 Now you've got the ST segment.

    03:04 So it's important that you understand particularly in looking at dysrhythmias understand what normal should look like.

    03:11 You've got a nice p-wave there.

    03:13 We've got a consistent P every QRS.

    03:16 Now, you're just looking at one complex.

    03:17 But if we're looking at a whole strip, those would be the things we look for a nice consistent P, every P looks the same.

    03:25 We've got a consistent length and the pr, the QRS and lead two what this is will be upright and look beautiful like that and be the appropriate length or width you might think and then we'll have the T wave as it resets, but what I want you to focus on right now is the ST segment.

    03:43 Does that make sense to you and can you see clearly what a normal text book ST segment will look like.

    03:51 Now we're going to look at when things go a little bit wrong.

    03:54 I want you to see some minimal ST segment depression.

    03:57 So you'll see in there that we've got just a little bit of ST segment depression is a sign of ischemia.

    04:03 You see where the baseline is what that just gives you an idea of what a small ST segment depression means.

    04:10 Now looking at a non-STEMI.

    04:13 There's a much more significant ST segment depression.

    04:16 So this is what you would see in an EKG during an STEMI, a non-STEMI a non ST segment elevation MI.

    04:25 It's got a little bit bigger ST depression.

    04:29 Also keep in mind at the same time we're evaluating this we're drawing lab work, we have the EKG, and we're looking at all kinds of factors multiple pieces to put this puzzle together.

    04:42 Now this is what you'll expect for an evolution of the changes during an acute MI.

    04:46 So a hyper acute or elevated T wave is only seen after the onset of the MI.

    04:53 So there we have normal and that top row, normal.

    04:56 Then we have a hyper acute T wave and then we have ST elevation.

    05:02 So look at the difference between normal and ST-elevation compare both of those to what you see in hyperacute T waves.

    05:10 I promise Is critically important that you understand normal in everything in healthcare, so you will recognize abnormal quickly and early and know what to do next.

    05:23 Now ST segment elevation can stick around for some days and this T wave inversion see it there.

    05:29 You see that they would T wave inversion how it looks different than what the normal one looks like.

    05:35 So we've got ST elevation in progress T wave normalizes again.

    05:40 So we Have a T wave inversion.

    05:43 So T wave inversion and Q waves may hang around for years as a sign of an old MI, but then we show you the difference between ST elevation is it is improving and when the T wave normalizes again, but keep in mind it could hang around as a sign of an old MI.

    About the Lecture

    The lecture Myocardial Infarction (MI): STEMI vs. NSTEMI (Nursing) by Rhonda Lawes, PhD, RN is from the course Acute Coronary Syndrome (Nursing) .

    Included Quiz Questions

    1. Transmural infarction
    2. Subendocardial infarction
    3. Intramural infarction
    4. Subepicardial infarction
    1. A STEMI shows ST segment elevation, and an NSTEMI shows ST segment depression
    2. A STEMI shows ST segment depression, and an NSTEMI shows ST segment elevation
    3. Both STEMI and NSTEMI show ST segment depression
    4. A STEMI shows an ST segment elevation, and an NSTEMI shows no ST segment
    1. Inverted T waves and the presence of Q waves
    2. The presence of T waves
    3. Peaked, hyperacute T waves
    4. Inversion of Q waves and peaked T waves

    Author of lecture Myocardial Infarction (MI): STEMI vs. NSTEMI (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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