![]() ![]() Consider adjunct medical therapy for ACS, e.g., sublingual nitroglycerin for chest pain relief.Give aspirin if there are no contraindications.Initiate supplemental O 2 for cyanosis, respiratory distress, or SpO 2 Start continuous telemetry and pulse oximetry.Measure cardiac troponinas soon as possible upon clinical presentation.Establish IV access and obtain blood samples for laboratory studies.Obtain 12-lead ECG within 10 minutes of patient arrival.Perform a focused clinical evaluation and ABCDE survey.See “ Management of chest pain” for an approach to patients with undifferentiated chest pain. The following applies to patients with acute chest pain and suspected ACS. Clinical triad in right ventricular infarction : hypotension, elevated jugular venous pressure, clear lung fields Ĭlassically, it has been taught that STEMI manifests with more severe symptoms than NSTEMI, but this is not always the case.More common in inferior wall infarction.Autonomic symptoms (e.g., nausea, diaphoresis).Atypical presentations : more likely in elderly, diabetic individuals, and women.New heart murmur on auscultation (e.g., new S 4 ).Symptoms of CHF (e.g., orthopnea, pulmonary edema) or cardiogenic shock (e.g., hypotension, tachycardia, cold extremities).The peak time of occurrence is usually in the morning.Symptom relief after administration of nitrates is not a diagnostic criterion for cardiac ischemia.Commonly radiates to left chest, arm, shoulder, neck, jaw, and/or epigastrium.Typical: dull, squeezing pressure and/or tightness. ![]() STEMI) is determined based on ECG findings. Unstable angina is differentiated from MI by the presence of positive troponins, while the type of MI ( NSTEMI vs. Subtypes of ACS cannot be differentiated based on clinical presentation alone. See “ Acute management checklist for STEMI.”.Adjunctive medical therapy similar to NSTE-ACS.See “ Acute management checklist for NSTE-ACS.”.Anticoagulants, antiplatelet therapy (e.g., aspirin, ADP receptor inhibitors).Invasive management depends on risk stratification (e.g., TIMI score).ST elevations (in two contiguous leads) or new left bundle branch block with strong clinical suspicion of myocardial ischemia.Normal or nonspecific (e.g., ST depression, loss of R wave, T-wave inversion). ![]()
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