Unstable Angina: STEMI vs. NSTEMI (Nursing)

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.