An ST-elevation myocardial infarction, or STEMI heart attack, is often also called a widow-maker, this is the deadliest form of heart attack. It's the result of a complete blockage in the heart, and no blood is able to pass through.

Story by: Sara Thompson on October 30, 2023

When blood flow is partially blocked through one or more arteries to the heart, the heart muscle is damaged. This is a heart attack. But when the flow is blocked completely, damage happens much faster, and the condition is far more dangerous. The chances of recovery — and survival — lessen with every minute.

This kind of heart attack is called an ST-elevation myocardial infarction (my-oh-CARD’-ee-ull in-FARK’-shun), or STEMI. Often also called a widow-maker, this is the deadliest form of heart attack. That’s because it is caused from a complete blockage in the heart, and no blood is able to pass through. Restoring blood flow is all that matters, and the faster it’s done, the better the chances of recovery and preventing long-term damage to the heart muscle. In this situation, time is muscle.

Myocardial infarction is the medical term for a heart attack. An infarction is a blockage of blood flow to the myocardium (my-oh-CAR’-dee-um), the heart muscle. That blockage causes cells in the heart muscle to die.

A STEMI is a heart attack that causes a distinct pattern on an electrocardiogram (abbreviated either as ECG or EKG). This is a medical test that uses several sensors (usually 10) attached to your skin that can detect your heart’s electrical activity. That activity is then displayed as a wave pattern on a paper readout or a digital display. Certain patterns of heart activity mean there’s a total blockage of one of the heart’s main supply arteries.

During a heart attack, those patterns can mean the heart muscle is dying. At this point, the key goal is to reopen that artery and restore blood flow as soon as possible. This may prevent permanent damage, or at least limit the severity of the damage. If there’s too much damage to the muscle in the ventricles, your heart can’t pump enough blood to support your body. The heart muscle cannot repair itself. That’s why STEMI heart attacks are so dangerous and why restoring blood flow quickly is so critical.

Chest pain or heart attack?

Despite what you might have seen on TV or in movies, a heart attack does not always come on suddenly or include clutching one’s chest in agony. Many times, a heart attack feels like pressure, heaviness or other discomfort in the chest, neck, jaw or down the arms. Though men and women both have heart attacks, they often report different sensations in the body.

STEMI symptoms include:

• Tightness, squeezing, pain, or pressure in your chest that doesn’t go away after a few minutes, or stops and returns
• Pain or discomfort in your arms, neck, jaw, back, or stomach
• Shortness of breath
• Lightheadedness
• Nausea and vomiting
• A cold sweat

There are several conditions that can feel like a heart attack, including anxiety, gas and muscle strain. You always should err on the side of caution when it comes to chest pain, and visit a health care provider to see what the cause of your pain is.

STEMI treatment

Treatment options for STEMI will depend on several factors, including:

• Where the blockage is in your heart
• Results of tests such as ECG/EKG
• Age, general health and lifestyle factors

No matter what, treating a STEMI is time-sensitive. Faster treatment can mean better outcomes. If your blood oxygen levels are low, treatment may include supplemental oxygen. There are also several different potential treatments for heart attack, several of which may happen in sequence or at the same time.

Other treatments include:

• Percutaneous coronary (per-kew-TANE’-ee-us COR’-oh-nar-ee) intervention  (PCI) — this procedure uses a tiny balloon that inflates to clear the blockage in the artery. A stent may be used, which is a scaffold that unfolds to hold the artery open.
• Medication — several medications are usually given early on in the treatment of heart attack, including beta blockers and statins.
• Coronary artery bypass grafting (CABG) surgery — CABG (pronounced like “cabbage”) means a surgeon takes a blood vessel from somewhere else in your body and uses it to make a new blood vessel that bypasses the blockage. CABG is often called bypass surgery or open heart surgery.

STEMI heart attack care network

Norton Healthcare has worked with Louisville-area health systems, emergency medical services (EMS) providers, air transport providers and affiliates to build the area’s first regional STEMI network. Like a top-notch pit crew for a race car, everyone on the team has a specific role: From the time you first seek medical care to the time the blockage is cleared, the STEMI network has your care covered.  

Part of the network’s purpose is to equip EMS crews with EKG equipment that can detect a STEMI heart attack. When a 911 call is made and EMTs arrive to provide care, the EKG taken in the first moments is sent to the STEMI network, activating a team that begins to prepare for the arrival of a patient. In some cases, the crew can save time by skipping what may be the closest hospital and heading directly to an accredited chest pain center where staff have been trained in heart attack care.

The goal is to get blood flowing within 90 minutes or less. Norton Heart & Vascular Institute and its partners in the STEMI network — which reaches into rural parts of Kentucky and Southern Indiana — beat the goal nearly 100% of the time. In 2022, Norton Healthcare had a median time of 56 minutes.

Norton Healthcare partners with other providers and emergency personnel who encounter STEMI patients to conduct drills and improve processes. This partnership was instrumental in the American Heart Association awarding its Mission Lifeline: Trailblazer designation to Norton Healthcare, thus recognizing the pioneering work done to create network of care to treat STEMI hear attacks.