Unstable Angina: STEMI vs. NSTEMI (Nursing)

by Prof. Lawes

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    00:00 So you're looking at syndromes here's unstable angina, right? The artery is partially occluded.

    00:06 So it's got enough of a problem that those heart cells are not getting the blood supply that they need.

    00:11 So you're flipping over that anaerobic metabolism.

    00:13 And it has muscles are all fibered.

    00:16 That's unstable angina.

    00:20 Now I want to get break that down even more for you and look at non-ST segment elevation and ST segment elevation.

    00:28 These are really significant cardiac events and you are more than capable of recognizing these but we're going to talk about EKGs just a little bit.

    00:38 So in anions ST-segment, we call that NSTEMI.

    00:42 So a non-stemi the artery might be partially occluded.

    00:46 We know an unstable.

    00:47 It is partially occluded, we know and non-stemi that artery might be partially occluded.

    00:53 But if you're looking at a stemi, this one is much more serious.

    00:58 Now, I just looking at the pictures because you're pretty good at deciphering these now.

    01:02 Why do you think a stemi is worse than a non-stemi? Right.

    01:08 With the stemi the artery is totally occluded by a thrombus.

    01:12 So this one is more serious.

    01:14 None of these three are things that you want to experience.

    01:17 But if I had to pick which one had the highest risk for significant complications and infarcted issue.

    01:23 Yeah, we're looking at stemi.

    01:26 But here's where it gets really fun.

    01:28 We've broken down an electrocardiogram for you.

    01:30 So this is talking about the flow of electrical depolarization current in your heart.

    01:36 Now we know the way electricity is supposed to go through your heart got these pacemakers in your heart SA node, AV node, bundle of his, branch purkinje fibers.

    01:46 You've got those as it moves all the way through the heart that classic P wave, QRS-T that's just everything depolarizing.

    01:56 That means that the electric signal is moving through the heart and then the organs are responding.

    02:02 So when it moves through here, we're seeing the atrium respond and the ventricle respond the P wave is indicating the atrium responding depolarizing and compressing, you've got a little bit of time till that signal hits the ventricle that is the QRS, then it resets.

    02:20 So that's why looking at EKGs can be really really fun.

    02:24 You can get a feel for this is known as lead two but we're not going to break down 12 leads.

    02:29 We're going to talk to this is just a basic five lead view in the classic lead two.

    02:34 But you see there we've got different color coded for see the P wave is on the left and that's that beautiful hump.

    02:41 It's a good idea that p waves all look the same and then we see the PR segment.

    02:47 That's the space in between atrial depolarization and the ventricular depolarization, which is that beautiful QRS complex.

    02:55 Most patients don't look this pretty on their rhythms, but we've made it textbook for you so you can see what it looks like.

    03:03 Okay in a perfect world.

    03:05 So now we've got the ST segment.

    03:07 The T wave and the U wave.

    03:10 All right those I promise are the basic pieces of any EKG, ECG that you're looking at.

    03:16 It just depends which lead you're in because I mean to just have a little bit different perspective or angle on the heart just like a photographer can take a picture one way or one way or the other.

    03:27 That's all the different leads do like this is lead two but there's other perspectives, you could look at the heart from different angles.

    03:35 That's why the leads are different.

    03:37 Let's take a look at this strip.

    03:39 Now this should look very similar to what we just look like with all the rainbow colors.

    03:43 You see the P waves and they march right along.

    03:46 They look the same.

    03:48 You've got QRS complexes.

    03:49 And for every P wave I've got a QRS P wave QRS P wave QRS.

    03:54 That's how we break a strip down and this would be sinus rhythm.

    03:58 This is considered the normal rhythm.

    04:02 Normal EKG complexes P for every QRS.

    04:06 We got the T.

    04:07 Life is good.

    04:08 Things are looking good.

    04:10 Now we're not teaching you how to read these strips from here.

    04:13 We just want you to be very clear on what is normal so you can recognize what it'll look like in an abnormal experience.

    04:20 Now see this is an abnormal T wave.

    04:23 I have normal on the left, but look at the right, not hard for you to see what's wrong with that right that T wave looks very different.

    04:31 Notice that it's elevated.

    04:34 That's when we know we have a problem, go back to those names.

    04:37 Non-ST segment elevated and stemi ST. Elevated MI.

    04:44 This is when we get really concerned with abnormal T waves, we know something is going on whether they're elevated or depressed.

    04:53 There's something that needs our attention.

    04:55 So since these as T segments were in between those two ways PQRS, and ST segment there we've highlighted it with green boxes for you and the top one, the T waves are these are elevated and abnormal in the bottom one.

    05:11 There is a depression but it's still abnormal.

    05:14 So a non-stemi, you can have a large ST segment depression, right? Because we know what normal is now we can see that that is depressed or lower.

    05:22 This is what an EKG might look like during a non-stemis, now which one is worse absolutely a stemi is worse because non-ST segment elevated myocardial infarctions NSTEMIs can show ST-Segment depression when you do an EKG.

    05:40 Now if the ST segment depression can also be caused by a reversible myocardial ischemia.

    05:45 Cool! So if you're going to give me a choice do I want depressed ST's or do I want elevated? I will take depressed please.

    05:52 Thank you.

    05:53 That's what I'm looking for because we have a chance to fix it before that tissue damage becomes pretty severe.

    05:59 So non-stemi is less serious, less risk of long-term complications than a stemi.

    06:07 Let's look at a stemi.

    06:09 That's an ST-elevation myocardial infarction.

    06:12 The ST segment is elevated, right? It's higher and the experience more damage and have a worse prognosis than it non-stemi.

    06:20 So that's an important takeaway point from you more important than thinking you can interpret EKGs at this point unless you've been trained in it, but this is recognizing, Wow.

    06:29 Well that ST segment is elevated like that.

    06:32 This is a really serious sign of some potential heart damage.

    About the Lecture

    The lecture Unstable Angina: STEMI vs. NSTEMI (Nursing) by Prof. Lawes is from the course Acute Coronary Syndrome (Nursing) .

    Included Quiz Questions

    1. ST elevation on ECG
    2. Chest pain unresolved by rest
    3. Partial artery blockage
    4. ST depression on ECG
    1. STEMI
    2. NSTEMI
    3. Acute coronary syndrome
    4. Unstable angina
    1. NSTEMI
    2. STEMI
    3. Coronary artery disease
    4. Sudden cardiac arrest

    Author of lecture Unstable Angina: STEMI vs. NSTEMI (Nursing)

     Prof. Lawes

    Prof. Lawes

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