Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of substernal chest pressure radiating to the epigastrium and jaw, associated with diaphoresis, nausea, and vomiting. Symptoms are persistent, non-pleuritic, and unresponsive to sublingual nitroglycerin. No history of recent trauma or syncope.
Clinical Examination Findings
Patient appears diaphoretic and in acute distress. Vital signs reveal bradycardia or hypotension suggestive of right ventricular involvement. Cardiac exam: S1, S2 present, no murmurs or rubs. Pulmonary exam: Lungs clear to auscultation bilaterally. Abdominal exam: Soft, non-tender, no guarding or rebound. Peripheral pulses: 2+ symmetric, no peripheral edema.
Treatment Protocol
Immediate activation of Cardiac Catheterization Lab for primary PCI. Administer Aspirin 325mg chewed, P2Y12 inhibitor (Ticagrelor/Clopidogrel), and anticoagulation (Heparin). Initiate high-intensity statin therapy. Avoid nitrates if right ventricular infarction is suspected (hypotension). Monitor for AV block and arrhythmias.