STEMI (ST-elevation heart attack): emergency signs, treatment and recovery

The NHS says a heart attack happens when blood flow to the heart is blocked, that it can be life-threatening and needs emergency treatment in hospital. The BHF explains that most heart attacks are caused by coronary heart disease: the coronary arteries narrow through a gradual build-up of fatty deposits called atheroma, a piece of atheroma can break off, and a blood clot forms around it and blocks the artery, starving the heart muscle of blood and oxygen.

Doctors classify heart attacks using the ECG. A European case report published in a PubMed Central journal states that acute coronary syndromes are usually classified by the presence or absence of ST elevation on the ECG, giving ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI). That means STEMI is not a different disease from a heart attack but a particular ECG pattern that, in practice, triggers an urgent pathway to reopen the artery. You may also hear a heart attack called acute coronary syndrome, myocardial infarction or coronary thrombosis in hospital, according to the BHF.

The NHS lists chest pain that may feel like crushing or squeezing and may spread to the arm, neck and jaw, shortness of breath, feeling or being sick, indigestion-like burning or fullness, sweating, and pale, blue or grey skin. The BHF adds light-headedness, pain spreading to the upper back or stomach, and less common symptoms such as sudden anxiety similar to a panic attack, severe tummy pain and lots of coughing or wheezing. Symptoms vary and you may not have all of them.

The BHF explains how a heart attack differs from cardiac arrest: in a heart attack there is sudden loss of blood flow to part of the heart muscle, while in cardiac arrest the heart suddenly stops pumping blood around the body. It also notes that women generally experience the same heart attack symptoms as men but tend to recognise them as a heart attack less quickly, and that on average 3 women in the UK die of coronary heart disease every hour.

• Chest pain or pressure that does not settle.

• Pain spreading to the arms, neck, jaw, back or stomach.

• Breathlessness, nausea, sweating, light-headedness.

• Pale, blue or grey skin.

The NHS says to call 999 if you have chest pain that feels tight or like squeezing, chest pain spreading to the arms, neck or jaw, severe difficulty breathing, pale, blue or grey lips or skin, or if someone has passed out and is not responding normally. Do not drive yourself to A&E. While you wait, sit and rest on the floor or a chair in a comfortable position, take aspirin (300mg) if you have any and are not allergic, take your GTN spray if you have angina, and keep checking anyone who may be having a heart attack. If someone stops responding and stops breathing, start CPR.

The BHF says not to worry about wasting anyone's time and that delay raises the risk of serious heart damage and longer hospital stays. Paramedics will do an ECG, an important test to find out whether you are having a heart attack, and if it shows a heart attack you will be taken to a specialist centre for the best treatment. The BHF advises not to try to take yourself to hospital because the ambulance team will give care and do tests on the way.

The BHF says quick treatment to get blood flowing again reduces the amount of permanent heart damage and can save your life, and many people need emergency treatment to restore blood flow. A cardiology team chooses between angioplasty, thrombolysis and bypass surgery. The NHS notes that if tests show a heart attack, further tests may include an echocardiogram to see whether the heart has been damaged and a coronary angiogram to find exactly where the blood flow is blocked, sometimes treating the blockage at the same time. It also states that a heart attack is life-threatening and cannot always be treated, and that there is a chance someone who has one may die.

Tests after the acute phase include blood tests to see whether heart muscle has been damaged, repeat ECGs and an echocardiogram. You are likely to be admitted to a coronary care unit first and later moved to a cardiac ward.

The BHF says people usually stay in hospital for about 2 to 5 days, depending on treatment and recovery: probably 2 or 3 days after angioplasty or stents and at least a week after bypass surgery. The NHS says that for some people recovery takes several weeks with little impact on life, while for others it can take months or years. You will usually need to rest, including time off work, and be referred to cardiac rehabilitation, which may be in person or remote through video calls or apps. Most people can resume normal activities once recovered.

You will be given long-term medicines that treat the causes and reduce the risk of another attack, which may include antiplatelets, statins and medicines to lower blood pressure such as ACE inhibitors and beta-blockers, according to the NHS. Feeling anxious or low after a heart attack is common; the NHS says to talk to your GP if you have anxiety or low mood. Heart attack risk factors listed by the NHS include smoking, high blood pressure, high cholesterol and family history, and the BHF lists less common causes such as spontaneous coronary artery dissection and cocaine or amphetamine use.

A suspected STEMI is a 999 emergency in every setting. Ambulance crews can transmit the ECG and take you directly to a specialist heart attack centre, and emergency treatment is delivered on the NHS regardless of whether you hold private insurance. Follow-up includes cardiology clinic reviews, cardiac rehabilitation and GP monitoring of medicines and risk factors.

Private care becomes relevant afterwards, for example cardiology review, imaging, lifestyle and rehabilitation services, or a second opinion on long-term management. Ask how any private follow-up will be coordinated with your NHS cardiology team and GP.