NSTEMI: Non-ST-Elevation Myocardial Infarction

Report:

Sinus rhythm 63/min

Diffuse T wave inversion

Prolonged QTc 0.49”

Comment:

The patient’s presentation was “atypical” but, after all, she was a woman35. Diabetics may also have silent infarcts more than any other group, with their autonomic neuropathy.The T waves themselves were deep, symmetrical and (although not visible in this tracing) persistent: infarctional. The next day’s tracing is shown below (Fig 38a). Troponin level rose to 14 µ/L.

This is one of the presentations of the newly formulated non-ST-elevation infarction (NSTEMI). It has some operational value but, in ECG terminology, it is not particularly useful. The established non-Q infarction would be better, for the very reason that it was established. Subendocardial would be best-sounding of all, except that it is clearly wrong in terms of what it specifically means in enough cases to preclude its further use. None of the terms actually distinguish transmural from subendocardial MI; the last one pretends to do so.

My view is that names matter little and should be changed even less: those who know, know and those who do not will not be helped by learning the new ones. They matter less than is commonly held36. It may well be that ST segment deviation, rather than elevation, is what really matters37. As to T waves, there will never be an immediate certainty about their significance.

38a. Unchanged ECG the next day. 39. 78 year old man, two days before his death.