Algorithm for Evaluation and Treatment of Pts with a Suspected Acute Coronary Syndrome

Algorithm for Evaluation and Treatment of Pts with a Suspected Acute Coronary Syndrome - Flowchart

«Flowchart»

Symptoms suggestive of ACS

Treatment as indicated by alternative diagnosis

End

ACS, acute coronary syndrome; cTn, cardiac troponin.

Noncardiac diagnosis

Chronic stable angina

Possible ACS

Definite ACS

Nondiagnostic ECG
Normal initial cTn

See Chap. 123

Admit to hospital
Manage via acute ischemia pathway

Observe 12 h or more from symptom onset

No recurrent pain; negative follow-up studies

No recurrent pain

Recurrent ischemic pain or positive follow-up studies
Diagnosis of ACS confirmed

Diagnosis of ACS confirmed Recurrent ischemic pain

Outpatient follow-up

Stress study to provoke ischemia
Consider evaluation of LV function if ischemia is present

Negative
Potential diagnoses: nonischemic discomfort; low-risk ACS

Potential diagnoses: nonischemic discomfort; low-risk ACS Negative

Positive
Diagnosis of ACS confirmed or highly likely

Diagnosis of ACS confirmed or highly likely Positive

See Chap. 121

No ST-segment elevation

ST-segment elevation

Nondiagnostic ECG
Normal initial cTn

Nondiagnostic ECG

ST- and/or T-wave changes
Ongoing pain or elevated cTn
Hemodynamic abnormalities

ST- and/or T-wave changes