Tips for identifying acute coronary syndrome (ACS)

The American College of Cardiology and the American Heart Association have issued guidelines to help clinicians identify acute coronary syndrome (ACS), categorize a patient's immediate risk; and use clinical findings, new cardiac markers, and electrocardiographic readings to take decisive action. The 94-page guidelines are on the American College of Cardiology web site at http://www.acc.org/clinical/guidelines/unstable/unstable.pdf.

Here are several of the recommendations, pertinent to NPs:

History-taking

• Patients who call ahead for advice should be told that possible heart disease cannot be assessed by phone.
• All patients who present with pressure-type or heavy chest pain or tightness must be assumed to have possible ACS.
• A patient who complains of indigestion, belching, cramping, epigastric pain, persistent shortness of breath, weakness, dizziness, lightheadedness, or loss of consciousness should also be evaluated for ACS.

Studies

• If suspecting ACS, perform an ECG within 10 minutes of arrival, and preferably within five minutes of arrival, without delays for registration and a detailed history.

Treatment Measures

• Immediately after obtaining an ECG with ST-T wave abnormalities arrange for transport to an emergency facility, preferably a facility with a chest-pain unit. The guidelines state "If an ambulance may be delayed more than 20 to 30 minutes, transport by a driver in a personal vehicle may be an acceptable alternative."

This tip is excerpted from The Gold Sheet, a monthly newsletter from the Law Office of Carolyn Buppert. For a 12-month subscription, send a check for $30 to Law Office of Carolyn Buppert, 1419 Forest Dr., Suite 205, Annapolis, MD 21403.

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