Non-ST-elevation myocardial infarction: dual etiology, twoway therapy
In regularly updated myocardial infarction guidelines, infarctions, including non-ST-elevation myocardial infarction (NSTEMI), were classified into 5 etiological groups, but not all characteristic features of NSTEMI can be explained in all groups (myocardial necrosis occurs without ST-elevation; pro...
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Promenade Kft
2025-07-01
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| Series: | Cardiologia Hungarica |
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| Online Access: | https://cardiologia.hungarica.eu/archive/2025-issues/2025-3-contents/non-st-elevation-myocardial-infarction-dual-etiology-twoway-therapy |
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| _version_ | 1849410065670340608 |
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| author | Mihály Medvegy Nóra Medvegy |
| author_facet | Mihály Medvegy Nóra Medvegy |
| author_sort | Mihály Medvegy |
| collection | DOAJ |
| description | In regularly updated myocardial infarction guidelines, infarctions, including non-ST-elevation myocardial infarction (NSTEMI), were classified into 5 etiological groups, but not all characteristic features of NSTEMI can be explained in all groups (myocardial necrosis occurs without ST-elevation; prognosis is poor; connection with stress; anxiolytic/antidepressant administration is useful).
Objective: To refine pathophysiology and to find an etiological explanation for the properties of NSTEMI.
Method: Literature research was conducted on NSTEMI, fluid flow, microvascular dysfunction (MD) and sympathicotonia.
Results/information: Proven properties of NSTEMI: electrical potential loss can be detected and localized; the one-year mortality is higher compared to ST-elevation myocardial infarction; enzyme kinetics are uneven and prolonged; administration of antidepressants/anxiolytics and early intervention in culprit lesions are beneficial. The information obtained on the basis of the law of fluid flow: in a closed pipe, the flow-reducing effect of successive constrictions is cumulated. Information about MD: it is a consequence of various clinical pathologies; it can cause severe myocardial ischemia or infarction even without coronary artery disease (CAD); its quantitative determination is recommended – mainly in non-obstructive CAD; stress/sympathicotonia can acutely worsen MD and increase the incidence of myocardial infarctions in the case of earthquake, stroke, depression, anxiety, persistent pain, cancer, extreme physical exertion. Elevated blood sugar levels (which indicate sympathicotonia, but also worsen MD) indicate a poor prognosis.
Conclusion: All the characteristics of NSTEMI can be explained by the dual etiology that is valid in all groups and is inferred from the above data: "NSTEMI is caused by the acute deterioration of one of two concomitant pathologies (MD/generalized hypoxia and CAD)". MD deterioration is triggered by various acute stressors, most often sympathetic tone enhancement (stress). There is no ST-elevation, because even in spite of obstructive CAD, the blood supply to the subepicardium is still sufficient. The dual etiology is evidenced by the fact that both the improvement of CAD and the reduction of hypoxia/sympathicotonia have a beneficial effect, so both causes must be treated. |
| format | Article |
| id | doaj-art-4e3f92e98a734f99925291633b50c401 |
| institution | Kabale University |
| issn | 0133-5596 1588-0230 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Promenade Kft |
| record_format | Article |
| series | Cardiologia Hungarica |
| spelling | doaj-art-4e3f92e98a734f99925291633b50c4012025-08-20T03:35:16ZengPromenade KftCardiologia Hungarica0133-55961588-02302025-07-0155317618310.26430/CHUNGARICA.2025.55.3.176Non-ST-elevation myocardial infarction: dual etiology, twoway therapyMihály Medvegy0Nóra Medvegy1Flór Ferenc Hospital, Cardiology Department, KistarcsaEgis Pharmaceuticals Plc., BudapestIn regularly updated myocardial infarction guidelines, infarctions, including non-ST-elevation myocardial infarction (NSTEMI), were classified into 5 etiological groups, but not all characteristic features of NSTEMI can be explained in all groups (myocardial necrosis occurs without ST-elevation; prognosis is poor; connection with stress; anxiolytic/antidepressant administration is useful). Objective: To refine pathophysiology and to find an etiological explanation for the properties of NSTEMI. Method: Literature research was conducted on NSTEMI, fluid flow, microvascular dysfunction (MD) and sympathicotonia. Results/information: Proven properties of NSTEMI: electrical potential loss can be detected and localized; the one-year mortality is higher compared to ST-elevation myocardial infarction; enzyme kinetics are uneven and prolonged; administration of antidepressants/anxiolytics and early intervention in culprit lesions are beneficial. The information obtained on the basis of the law of fluid flow: in a closed pipe, the flow-reducing effect of successive constrictions is cumulated. Information about MD: it is a consequence of various clinical pathologies; it can cause severe myocardial ischemia or infarction even without coronary artery disease (CAD); its quantitative determination is recommended – mainly in non-obstructive CAD; stress/sympathicotonia can acutely worsen MD and increase the incidence of myocardial infarctions in the case of earthquake, stroke, depression, anxiety, persistent pain, cancer, extreme physical exertion. Elevated blood sugar levels (which indicate sympathicotonia, but also worsen MD) indicate a poor prognosis. Conclusion: All the characteristics of NSTEMI can be explained by the dual etiology that is valid in all groups and is inferred from the above data: "NSTEMI is caused by the acute deterioration of one of two concomitant pathologies (MD/generalized hypoxia and CAD)". MD deterioration is triggered by various acute stressors, most often sympathetic tone enhancement (stress). There is no ST-elevation, because even in spite of obstructive CAD, the blood supply to the subepicardium is still sufficient. The dual etiology is evidenced by the fact that both the improvement of CAD and the reduction of hypoxia/sympathicotonia have a beneficial effect, so both causes must be treated.https://cardiologia.hungarica.eu/archive/2025-issues/2025-3-contents/non-st-elevation-myocardial-infarction-dual-etiology-twoway-therapynon-st-elevation myocardial infarctionpathophysiologysympathicotoniamicrovascular dysfunction |
| spellingShingle | Mihály Medvegy Nóra Medvegy Non-ST-elevation myocardial infarction: dual etiology, twoway therapy Cardiologia Hungarica non-st-elevation myocardial infarction pathophysiology sympathicotonia microvascular dysfunction |
| title | Non-ST-elevation myocardial infarction: dual etiology, twoway therapy |
| title_full | Non-ST-elevation myocardial infarction: dual etiology, twoway therapy |
| title_fullStr | Non-ST-elevation myocardial infarction: dual etiology, twoway therapy |
| title_full_unstemmed | Non-ST-elevation myocardial infarction: dual etiology, twoway therapy |
| title_short | Non-ST-elevation myocardial infarction: dual etiology, twoway therapy |
| title_sort | non st elevation myocardial infarction dual etiology twoway therapy |
| topic | non-st-elevation myocardial infarction pathophysiology sympathicotonia microvascular dysfunction |
| url | https://cardiologia.hungarica.eu/archive/2025-issues/2025-3-contents/non-st-elevation-myocardial-infarction-dual-etiology-twoway-therapy |
| work_keys_str_mv | AT mihalymedvegy nonstelevationmyocardialinfarctiondualetiologytwowaytherapy AT noramedvegy nonstelevationmyocardialinfarctiondualetiologytwowaytherapy |