Legal Tips
Provided by Carolyn Buppert, MSN, JD, ANP

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

Here are several of the recommendations, pertinent to NPs:


  • 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.


  • 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.

Updated November 13, 2001


NP Central
10024 S.E. 240th St., Suite #102, Kent, WA 98031
Phone: 253.852.9042 Fax: 253.852.7725
NP Central Gateway

Use of this section indicates you agree to the Terms of Use.
Copyright 1994-2003 NP Central