Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of substernal chest pressure, radiating to the left jaw and arm, occurring at rest/minimal exertion. Symptoms are associated with diaphoresis and mild dyspnea. No syncope, palpitations, or focal neurological deficits. TIMI score calculated at 3-4 (Intermediate Risk). Cardiac biomarkers (Troponin I/T) are elevated above the 99th percentile URL. ECG demonstrates ST-segment depression >0.5mm or T-wave inversion in contiguous leads without ST-elevation.
Clinical Examination Findings
General: Patient appears distressed, diaphoretic, and pale. Vitals: BP [X/X] mmHg, HR [X] bpm (regular/irregular), RR [X] bpm, SpO2 [X]% on room air. Cardiovascular: S1/S2 audible, no murmurs, rubs, or gallops. Peripheral pulses symmetric, 2+ bilaterally. No peripheral edema. Pulmonary: Clear to auscultation bilaterally, no rales or wheezes. Abdomen: Soft, non-tender, non-distended. Neurological: Alert and oriented x3, no focal deficits.
Treatment Protocol
1. Admit to Cardiac Care Unit (CCU) for continuous telemetry monitoring. 2. Dual Antiplatelet Therapy (DAPT): Aspirin 325mg (loading) followed by 81mg daily; P2Y12 inhibitor (e.g., Ticagrelor or Clopidogrel) as per protocol. 3. Anticoagulation: Enoxaparin 1mg/kg SC BID or Unfractionated Heparin infusion per nomogram. 4. Anti-anginal: Nitroglycerin SL/IV as needed; Beta-blocker (e.g., Metoprolol) if hemodynamically stable. 5. High-intensity Statin therapy (e.g., Atorvastatin 80mg). 6. Early invasive strategy (coronary angiography) planned within 24-48 hours.