Myocardial Infarction (STEMI Vs NSTEMI)

Acute coronary syndrome (ACS) is a spectrum: unstable angina, NSTEMI, and STEMI. STEMI and NSTEMI describe the presenting ECG pattern; they do not divide patients into safe and unsafe groups. An NSTEMI can still cause extensive myocardial damage, malignant dysrhythmia, or cardiogenic shock. At the bedside, use three linked questions: Is the patient showing myocardial ischemia now? Does the ECG indicate an immediate STEMI reperfusion pathway? Is circulation deteriorating? ASA and P2Y12 inhibitors limit platelet-driven thrombus, reperfusion restores coronary flow, and anti-ischaemic drugs can help or harm depending on blood pressure, right-ventricular involvement, oxygenation, bleeding risk, and recent medications.