Acute Coronary Syndrome: From Triage to Reperfusion

A practical, evidence-oriented pathway for suspected ACS. Stabilize ABCs, get ECG fast, use high-sensitivity troponin deltas with the clinical picture, and move decisively toward reperfusion when indicated.

Overview

Obtain ECG within minutes and repeat if symptoms evolve. Use 0/1-h or 0/2-h hs-troponin algorithms with deltas.

Key Takeaways

• STEMI → immediate cath lab activation.
• Non-diagnostic ECG → rely on deltas + risk; avoid type-2 MI overcalls.
• Right antithrombotic at the right time; avoid duplication and bleeding traps.

Pathophysiology

Plaque rupture/erosion → platelet activation and thrombin generation → thrombotic occlusion.

Diagnosis

• ECG: STEMI criteria, posterior MI, dynamic changes.
• hs-Troponin: thresholds + delta with time; correlate with symptoms/ECG.
• Mimics: myopericarditis, PE, sepsis, renal failure, takotsubo.

Management

• STEMI: PCI without delay; guideline antithrombotics.
• NSTEMI: risk-stratify; early invasive for high-risk features.
• Oxygen only if hypoxemic; avoid routine NSAIDs.

Red Flags

• Shock, pulmonary edema, malignant arrhythmias, refractory chest pain, syncope.

References & Notes

Follow local ACS protocols and major cardiology society guidance. Educational only.