Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of severe, persistent substernal chest pain radiating to the left arm/jaw, consistent with previous MI symptoms. History significant for recent coronary stent placement (within [X] days/months). Symptoms unresponsive to sublingual nitroglycerin. Associated symptoms include diaphoresis, nausea, and dyspnea. No recent history of medication non-compliance (DAPT).
Clinical Examination Findings
Patient appears in acute distress, diaphoretic, and pale. Vitals: Tachycardic, hypertensive/hypotensive, O2 saturation [X]%. Cardiovascular: S1/S2 present, S3 gallop noted, no murmurs. Lungs: Bilateral crackles at bases. Extremities: Cool, clammy, no peripheral edema. ECG: ST-segment elevation in [leads] consistent with acute stent thrombosis.
Treatment Protocol
Immediate activation of Cardiac Catheterization Lab for emergent coronary angiography and PCI. Administer loading dose of P2Y12 inhibitor and aspirin. Initiate IV heparin bolus per protocol. Monitor for hemodynamic instability; prepare for mechanical circulatory support (e.g., IABP or Impella) if cardiogenic shock develops. Optimize DAPT regimen post-procedure.