02/21/2025
By Hal Wasserman, MD, Director, Cardiac Catheterization Laboratory
Caminati and Eppler Family Endowed Chair in Interventional Cardiology
A ST-elevation myocardial infarction (STEMI) is the most serious life-threatening type of heart attack caused by complete blockage of one of the arteries of the heart. Rapid intervention is crucial to minimize heart damage and improve survival. Here’s what a typical patient journey looks like—from the first signs of a heart attack to recovery.
Emergency Department (ED) and diagnosis
A STEMI often begins with severe chest pain, shortness of breath, nausea and/or sweating. Some patients may have less typical symptoms such as profound weakness, anxiety or upset stomach.
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Patients who think they may be having a heart attack should activate 911. First responders can provide lifesaving care and diagnose the STEMI enroute to the hospital. Upon arrival at the ED—either by ambulance or self-transport—an electrocardiogram (ECG) is performed immediately. If the ECG shows ST-segment elevation, a STEMI is diagnosed, and time-sensitive protocols are activated.
Medical staff will:
- Administer oxygen, aspirin, nitroglycerin and blood thinners to reduce clotting.
- Start an IV line for medications like heparin or beta-blockers.
- Obtain blood tests to check heart enzyme levels, confirming heart muscle damage.
Learn more about interventional cardiology at Nuvance Health.
Cath lab and revascularization
The gold standard treatment for STEMI is primary percutaneous coronary intervention (PCI), which should ideally be performed within 90 minutes of first medical contact. The patient is rushed to the cardiac catheterization lab (cath lab), where an angiogram reveals the blocked artery.
A stent is typically placed to restore blood flow to the heart muscle and reduce damage.
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Critical care and hospital stay
After PCI, the patient is monitored in the coronary care unit (CCU) or intensive care. The heart’s rhythm, blood pressure and oxygen levels are closely watched.
- Medications such as aspirin and another blood thinner, beta-blockers, ACE inhibitors and statins help prevent complications and future heart attacks.
- An echocardiogram assesses heart function and extent of damage.
Most patients remain in the hospital for 2 to 5 days, depending on their condition.
Recovery and long-term care
Discharge doesn’t mean the journey is over. The recovery phase includes:
- Cardiac rehabilitation, a structured program of monitored exercise and education.
- Lifestyle modifications, such as quitting smoking, eating a heart-healthy diet and managing stress.
- Medication adherence to prevent future cardiac events.
- All of these improve survival and reduce the risk of future heart attacks.
Patients will have regular follow-up with their cardiologist to ensure heart health and prevent recurrence. With the right care, most STEMI survivors go on to lead normal, active, fulfilling lives.
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The bottom line: A STEMI is a medical emergency requiring swift action. From the ED to the cath lab, critical care and long-term recovery, every step is designed to minimize heart damage and maximize survival. Prompt treatment, rehabilitation and lifestyle changes are key to a strong recovery. Remember, if you think you may be having a heart attack, call 911!
Learn more about the Heart and Vascular Institute at Nuvance Health.