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Pathophysiology of NSTEMI vs STEMI: Pathophysiologically, NSTEMI is somewhat different from STEMI. NSTEMI occurs by developing a complete occlusion of a minor coronary artery or a partial occlusion of a major coronary artery previously affected by atherosclerosis. This causes a partial thickness damage of heart muscle.
If the blockage is complete, a STEMI occurs. In a STEMI, the ST segments on the electrocardiogram become elevated (hence, the name), and cardiac enzymes greatly increase. These findings indicate that significant heart cell death is occurring. With unstable angina and NSTEMI, the blockage is not (yet) complete. Clinically, NSTEMI is identical to unstable angina except for one thing. In NSTEMI, in contrast to unstable angina, the cardiac enzyme blood tests are abnormal, indicating that at least some actual cell damage is occurring to heart muscle cells.