Pages IV-89 - IV-109

Although there are not many changes in this section, there is continued emphasis on the out-of-hospital 12-Lead ECG and transmission to speed time to treatment.

ACS

ACS includes acute myocardial infarction (AMI) and unstable angina - the spectrum of disease caused by a ruptured coronary artery or eroded plaque.

Presentation of ACS includes:

• ST elevated MI (STEMI)
• ST depression
• Non-diagnostic ST and T wave abnormalities
• Non-ST-elevated MI (NSTEMI). The patient has positive cardiac markers (blood tests for AMI) but no ECG changes

ACS definitions have been updated to align with the ACC/AHA STEMI Guidelines

Primary Goals of ACS Therapy

Reduce amount of muscle damage and preserve ventricles

Prevent major adverse cardiac events (MACE): death, nonfatal MI, need for urgent PCI

Treat acute, life-threatening complications such as VF and VT

Of course, to achieve this, providers need to identify, assess, triage and treat ACS as quickly as possible. To do this, a diagnostic 12-lead ECG must be done.

"Half of the patients who die of AMI do so before reaching the hospital. VF or pulseless VT is the precipitating rhythm in most of these deaths and it is most likely to develop during the first 4 hours after onset of symptoms." (p. IV-89)