Overview of approach to patients with suspected acute myocardial infarction in the emergency department

ED: emergency department; ECG: electrocardiogram; SL: sublingual; IV: intravenous; ACS: acute coronary syndrome; MI: myocardial infarction; PCI: percutaneous coronary intervention; CBC: complete blood count; PT: prothrombin time; aPTT: activated partial thromboplastin time; INR: international normalized ratio; BUN: blood urea nitrogen.
* Initial laboratory work may vary by institution, but often includes: serum cardiac biomarkers, CBC with platelet count, PT and INR, aPTT, basic electrolytes, magnesium, BUN, creatinine, blood glucose, and serum lipid profile. Contraindications to nitrates include: severe aortic stenosis, hypertrophic cardiomyopathy, suspected right ventricular infarct, hypotension, marked bradycardia or tachycardia, and recent use of phosphodiesterase 5 inhibitor (eg, Viagra).