DPDoctor's PassportEducation
Question bankPassport
Educational draft · awaiting clinical reviewUse this memory sheet for learning, not patient-care decisions. Verify current national and local ACS guidance and the BNF before acting.
Textbook/Cardiovascular/Acute coronary syndrome/Rapid
Rapid review · free60–90 secondsUK scope

Acute coronary syndrome

Essential recognition, diagnosis and immediate management.

Memory sheetSources checked 27 Aug 2026Clinical review pending
!
Do not wait for troponin when the patient is unstable or the ECG shows STEMI.

Arrange immediate emergency assessment for ongoing or recurrent ischaemic symptoms, shock, pulmonary oedema, a serious arrhythmia or a compatible regional ST-elevation pattern.

Key points

  • Central pressure or tightness may occur with sweating, nausea, breathlessness or radiation.
  • A normal first ECG does not exclude ACS; repeat it when symptoms recur or suspicion remains.
  • Raised troponin means myocardial injury. Diagnose infarction only when the pattern and clinical evidence support ischaemia.
  • Actively consider aortic dissection, pulmonary embolism and other time-critical alternatives.

Investigation sequence

  1. 112-lead ECG immediately
  2. 2Serial high-sensitivity troponin
  3. 3Repeat ECG and add posterior or right-sided leads when indicated

Management priorities

ImmediateStabilise and transfer

Monitor with defibrillator access and give aspirin 300 mg unless contraindicated. Do not give routine oxygen when saturation is adequate.

STEMI · first-linePrimary PCI

Use the immediate reperfusion pathway; fibrinolysis is the alternative when timely PCI is unavailable.

NSTE-ACS · first-line when appropriateFondaparinux

2.5 mg SC once daily; avoid below CrCl 20 mL/min. Use immediate angiography if unstable, or consider it within 72 hours when predicted 6-month mortality is above 3%.

Open full textbook →Answer 2 questionsTake the 10-question Cardiology check