ACS click-through decision tree

Tap a node or use the branch buttons. Red badges = clock is running. The key exam trap: ECG separates STEMI vs NSTE-ACS; troponin separates NSTEMI vs unstable angina.

first ECG≤10 min

Map

Step 1

Chest pain / possible ACS

time-critical

Time-critical

ECG ≤10 min. If STEMI: activate cath lab immediately. Primary PCI target: ≤90 min if PCI-capable; transfer if PCI can occur ≤120 min.

If no timely PCI

For eligible STEMI presenting early, give fibrinolysis with door-to-needle ≤30 min, then transfer for angiography; rescue PCI if failed lysis.

NSTE-ACS trap

ECG does not label NSTEMI vs UA. Troponin positive = NSTEMI; persistently negative biomarkers with ischemic symptoms = unstable angina.

Core meds

Aspirin + P2Y12, anticoagulation, nitrates for pain, high-intensity statin, β-blocker if no contraindication, ACEi/ARB when indicated.