Presentations
Classic ACS causes crushing chest pressure radiating to the arm or jaw with diaphoresis and shortness of breath. Women, older adults, and diabetics often present atypically with fatigue, nausea, or back pain. Never dismiss a complaint just because it does not match the textbook.
Assessment
Obtain a 12-lead ECG within 10 minutes of patient contact. Look for ST elevation in contiguous leads that signals STEMI. Transmit the ECG and activate the cath lab early.
Treatment
Give oxygen only if hypoxic, aspirin unless contraindicated, and nitroglycerin if blood pressure allows. Provide analgesia as directed and monitor for arrhythmias. Be ready to defibrillate, as ventricular fibrillation is a common complication.