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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.
NSTEMI refers to non-ST elevation myocardial infarction. That is, parts of the heart muscle is infarcting without any ST elevations on the 12 lead EKG. Usually evidence of a NSTEMI is determined based on serial troponins (a cardiac enzyme). If there is any measurable amount of troponin in the blood, then heart muscle damage, of some sort, has occurred. In the absence of some other cause (PE, for instance, can cause a troponin elevation), NSTEMI is diagnosed.