Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute substernal chest pressure radiating to the left arm/jaw, associated with diaphoresis and dyspnea. Symptoms are consistent with myocardial ischemia. Concurrently, patient reports palpitations and irregular heart rhythm. No history of syncope. Troponin levels are elevated without ST-segment elevation on ECG. Rhythm strip confirms atrial fibrillation with rapid ventricular response.
Clinical Examination Findings
General: Patient appears distressed, diaphoretic, and tachypneic. Cardiovascular: Irregularly irregular heart rhythm, tachycardia, S1/S2 present, no murmurs/rubs/gallops. Pulmonary: Bilateral fine crackles at lung bases. Extremities: No peripheral edema, pulses 2+ and symmetric. Neurological: Alert and oriented x3, no focal deficits.
Treatment Protocol
Initiate ACS protocol: Dual antiplatelet therapy (DAPT), anticoagulation (heparin/LMWH), and high-intensity statin. Rate control for AF initiated with beta-blockers or non-DHP CCBs. Evaluate for early invasive strategy (coronary angiography). Monitor telemetry continuously for rhythm changes and ischemic ST-T wave evolution.