Stem cells in the treatment of a heart attack: a Non-STEMI

Stem cells in the treatment of a heart attack: a Non-STEMI

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What is the role of stem cell treatment of a heart attack: non-STEMI?

Non-STEMI or Non-ST elevation Myocardial Infarction is the dominant presentation of acute coronary syndrome. This occurs when the blood supplied to the heart muscle is suddenly blocked. Other presentations include unstable angina and STEMI or ST-Elevation Myocardial Infarction. Patients presenting with symptoms of chest pain with or without accompanying symptoms of shortness of breath, profuse sweating, nausea or syncope, and have evidence of myocardial necrosis with absence of ST elevation are considered to have a Non-STEMI. ST segment depression, transient ST elevation or deep T-wave inversion on the electrocardiogram may be present but are not necessary.
Stem cells in the treatment of a heart attack: What is the problem with a Non-STEMI?
Each year, it is estimated that almost 800,000 patients will experience an acute coronary syndrome of which 70% will have a Non-STEMI. Trends from the world data base of patients with acute coronary syndrome show that the percentage of patients with Non-STEMI is raising dramatically. Acute coronary syndrome is caused by plaque rupture or erosion with different degrees of superimposed thrombus or clot resulting in a decreased blood flow to the heart muscle. In most cases, the damage to the heart muscle is limited to the most inner layers of the myocardium and for this reason a Non-STEMI is called a minor or small heart attack. However, patients with Non-STEMI have more co morbidities, both cardiac and noncardiac. The patients are older (median age of 68), and they more often have had a previous MI, congestive heart failure, atrial fibrillation, diabetes and abnormal kidney function. The in-hospital mortality of Non-STEMI and STEMI is similar (approx. 4%) but by 12 months, patients with Non-STEMI have an increased risk of myocardial infarction, death and recurrent instability. Early events are related to recurrent plaque rupture and thrombus and late events are closely related to left ventricular dysfunction and heart failure.
Stem cells in the treatment of a heart attack: What is the conventional treatment of a Non-STEMI?
Upon presentation, the clinical history, angina symptoms and equivalents, physical exam, ECG, renal function and cardiac troponin can be integrated into an estimation of the risk of death and complications of ischemic events. The patient with a high risk, continuing chest pain, hemodynamic instability (decrease in blood pressure or worsening heart failure) and uncontrolled arrhythmias (such as ventricular tachycardia) should be treated with anticoagulants, ant platelets and treated with an invasive approach where the patient is taken to the cath lab for percutanous coronary intervention and coronary stenting if appropriate. Below is an example of a patient with Non-STEMI that was treated with coronary angioplasty and stenting of the circumflex artery.

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