When Your ED Won’t Call Cardiology—Are You Sure It’s STEMI?
Medicine Made Simple:
Chest pain often causes panic, and many people assume it always means a heart attack. In hospitals, doctors act quickly, but they don’t always call the cardiology team straight away. Why? Because not every chest pain or ECG change is a STEMI (the most serious type of heart attack). Emergency doctors carefully check symptoms, ECG results, and blood tests before involving cardiology. This blog explains how STEMI is diagnosed, why doctors sometimes hold back, and what patients and families should understand about this life-saving decision-making.
The Basics: What Is STEMI?
STEMI stands for ST-segment Elevation Myocardial Infarction. It is a type of heart attack where a major artery supplying blood to the heart is completely blocked. This blockage cuts off blood supply, leading to rapid damage of the heart muscle.
The name comes from the changes seen on an electrocardiogram (ECG): a “ST-segment elevation.” This pattern signals that a full blockage is present and urgent treatment is needed.
The best treatment is primary angioplasty (PCI), where doctors mechanically open the blocked artery. But before calling the cardiology team, the emergency department (ED) must be sure it is a true STEMI.
Why Every Chest Pain Is Not a Heart Attack
Chest pain is one of the most common reasons people come to the emergency department. But only a fraction of these cases turn out to be STEMI.
Other possible causes include:
Angina (temporary narrowing of arteries but not a full blockage).
Non-ST elevation myocardial infarction (NSTEMI), where the artery is only partially blocked.
Gastroesophageal reflux (acidity or heartburn).
Anxiety or panic attacks.
Lung problems like pneumonia or pulmonary embolism.
Muscle strain or rib injuries.
This is why emergency doctors must first rule out non-cardiac causes and then determine what type of heart problem, if any, is happening.
The Role of the ECG in Diagnosis
The ECG is the first test performed when a patient with chest pain arrives. It records the electrical activity of the heart.
For STEMI, the ECG shows a classic pattern: the ST segment on the tracing is elevated above the baseline.
But here’s the challenge: not all ST elevations mean a heart attack. Conditions that can mimic STEMI on ECG include:
Pericarditis (inflammation of the heart lining).
Early repolarization (a harmless ECG variation in young adults).
Left bundle branch block (a conduction problem in the heart).
Severe electrolyte disturbances.
If cardiology is called for every ST elevation, many patients would undergo unnecessary, invasive procedures. That’s why ED doctors look at the whole picture before making the call.
Troponin: The Blood Test That Confirms Damage
Along with the ECG, doctors order a blood test called troponin. Troponin is a protein released when heart muscle is damaged. High troponin levels strongly suggest a heart attack.
However, troponin can also rise due to other conditions such as kidney disease, infections, or even extreme physical exertion. So, while troponin helps confirm a heart attack, it must be interpreted along with symptoms and ECG findings.
How Emergency Doctors Decide When to Call Cardiology
Here’s the process most emergency departments follow:
Assess symptoms: Severe chest pain, sweating, shortness of breath, or pain radiating to the arm or jaw raise suspicion.
Perform an ECG immediately: If it shows clear ST elevation in specific leads, STEMI is likely.
Check for mimics: Doctors review the ECG carefully to make sure it’s not pericarditis, early repolarization, or another condition.
Order blood tests: Troponin levels help confirm ongoing heart muscle injury.
Look at the patient’s overall condition: If the patient is unstable, in shock, or having dangerous arrhythmias, cardiology is called urgently.
If all these point toward STEMI, the ED alerts the cardiology team without delay. But if the diagnosis is uncertain, doctors may wait for repeat ECGs or troponin results before activating the cath lab.
Why Hesitation Can Be the Right Choice
It may seem worrying if doctors hesitate to call cardiology, but it often prevents unnecessary procedures.
For example:
A young adult with chest pain and mild ST changes might actually have harmless early repolarization.
A patient with chest pain after an infection might have pericarditis, which doesn’t need PCI.
Someone with high troponin due to severe infection might not benefit from emergency PCI.
Calling cardiology for these patients could lead to unnecessary risks, anxiety, and costs.
STEMI vs NSTEMI: Why the Difference Matters
Patients often hear the terms STEMI and NSTEMI. Both are heart attacks, but their treatments differ.
STEMI: Caused by complete blockage of an artery. Needs immediate PCI.
NSTEMI: Caused by partial blockage. PCI may still be done, but not always as an emergency. Doctors may stabilize the patient with medicines before intervention.
This distinction is crucial. If the ED mistakes NSTEMI for STEMI, the patient may be rushed into unnecessary emergency PCI.
Common Misconceptions Patients Have
“Any chest pain means a heart attack.” Not true. Many conditions can mimic chest pain.
“If there’s ST elevation, it must be STEMI.” False. ECG changes can be misleading.
“Doctors are wasting time by not calling cardiology immediately.” In reality, they are ensuring the right treatment is given.
“NSTEMI is not serious.” Wrong. NSTEMI is still a heart attack, but it’s managed differently.
Patient Story: Understanding the ED’s Decision
Imagine this scenario:
A 40-year-old man comes to the ED with chest pain. His ECG shows ST changes, but they don’t look like classic STEMI. He has no risk factors for heart disease. The doctor orders troponin, which comes back normal. After careful review, the diagnosis is pericarditis, not STEMI.
If cardiology had been called immediately, this patient might have undergone unnecessary PCI. Instead, he received the right treatment for his condition.
This example shows why ED doctors sometimes wait before making the call.
What Patients and Families Should Learn
Not all chest pain is a heart attack, and not all heart attacks are STEMI. Doctors use a combination of symptoms, ECGs, and blood tests to make the right call.
Sometimes waiting for confirmation avoids unnecessary procedures. If it is STEMI, cardiology will be called immediately for life-saving PCI. The key is reaching the hospital early and trusting the medical team.
If you or someone you know has chest pain lasting more than a few minutes, don’t ignore it. Call emergency services immediately. Even if it turns out not to be a heart attack, it’s always safer to get checked. If it is STEMI, fast hospital arrival gives doctors the best chance to save heart muscle and life.
References and Sources:
American Heart Association. ECG and Heart Attack Diagnosis
American College of Cardiology. STEMI and NSTEMI Guidelines
European Society of Cardiology. Diagnosis of ACS
*Information contained in this article is not intended or designed to be a substitute for professional medical advice, diagnosis, or treatment. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other professional health care provider with any questions you may have regarding a medical condition or advice in relation thereto.
