Therapeutic Handbook - GGC Prescribing

Management of Suspected Acute CoronarySyndrome (ACS)N.B. Some of the recommendations in this guideline have been recently revised. Please check:StaffNet, Clinical guideline electronic resource directory and search in Cardiovascular system forfurther information.IntroductionChest pain is one of the most common presentations at A&E. There is a long list of differentialdiagnoses.Assessment / monitoringRecord ECG (continuous monitoring), take a good history, measure blood pressure and perform allgeneral assessment measures for an acute admission. Follow flow chart on the next page once ACSis established as the most likely cause of the presenting complaint.Test for troponin if acute coronary syndrome is suspected with a suggestive history (even if no ECGchanges) or there is another good clinical reason for testing. Troponin testing should not be usedas a catch-all test in a ‘routine’ battery.STEMIPrimary percutaneous coronary intervention (PPCI) is the treatment of choice and most patients willbe eligible. This is most effective when done as early as possible. Do not delay in making a decisionabout this – decisions will almost always be made in the ambulance or in A&E.Continues on next pageCardiovascular SystemPage 93