Acute Coronary Syndrome and Chest Pain
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Article at a Glance
- Chest pain, exhibited via retrosternal chest pressure or tightness, is a common ACS symptom.
- Ischemic chest pain may radiate to the jaw, arm, shoulder, and back.
- Practitioners should be aware of the differential diagnoses for chest pain.
- The STEMI Chain of Survival informs responders how to appropriately respond to a patient experiencing chest pain.
- Emergency dispatchers are often the first point of contact for ACS patients and play an important role in the STEMI Chain of Survival.
Identification of Chest Discomfort Suggestive of Ischemia
Acute Coronary Syndromes Algorithm
Chest pain is a symptom of ACS.1 Patients will complain of retrosternal chest discomfort. Pressure or chest tightness is a common symptom. Pain may radiate to the shoulders, neck, arms and jaw, while chest discomfort is sometimes present between the shoulder blades. Patients may also complain of light-headedness, dizziness, syncope or near syncope, diaphoresis, or vomiting. A significant finding is sudden shortness of breath with or without chest discomfort. Common differential diagnoses include aortic dissection, acute pulmonary embolism, acute pericardial effusion with tamponade, and tension pneumothorax. Chest pain is a common symptom of acute coronary syndrome.Ischemic Chest Discomfort Symptoms
Read: Acute Coronary Syndrome: Emergency Medical Services
The four links of the American Heart Association STEMI Chain of Survival. The American Heart Association STEMI Chain of Survival illustrates responder actions when a patient may be experiencing ACS2. The links are: The FIRST link represents the interaction between the ACS symptomatic patient and the emergency dispatcher. Trained dispatchers prescribe emergency medications over the phone. For example, dispatchers can recommend aspirin to ACS patients, but they should be able to diagnose the patient accurately through the phone and make sure that the patient has no contraindications to taking aspirin (such as allergies or gastrointestinal bleeding). Chest paint, pressure, and tightness are symptoms of ACS. Patients may feel ischemic pain throughout their jaw, arms, shoulders, and back. Responders must know how to recognize ACS to administer effective treatment, utilizing the STEMI Chain of Survival.STEMI Chain of Survival
Related Video – Acute Coronary Syndrome: ACLS Algorithm
Summary
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Editorial Sources
ACLS Certification Association (ACA) uses only high-quality medical resources and peer-reviewed studies to support the facts within our articles. Explore our editorial process to learn how our content reflects clinical accuracy and the latest best practices in medicine. As an ACA Authorized Training Center, all content is reviewed for medical accuracy by the ACA Medical Review Board.
1. Mayo Clinic. Acute Coronary Syndrome. 2021.
2. American Heart Association. Systems of Care for ST-Segment–Elevation Myocardial Infarction: A Policy Statement From the American Heart Association. 2021.
3. Journal of the American Heart Association. Performance of Emergency Department Screening Criteria for an Early ECG to Identify ST‐Segment Elevation Myocardial Infarction. 2017.
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