People with presumed<unk>  are typically treated with aspirin, clopidogrel or ticagrelor, nitroglycerin, and if the chest discomfort persists morphine. Other analgesics such as nitrous oxide are of unknown benefit. Angiography is recommended in those who have either new ST elevation or a new left or right bundle branch block on their ECG. Unless the person has low oxygen levels additional oxygen does not appear to be useful. STEMI If the ECG confirms changes suggestive of myocardial infarction (ST elevations in specific leads, a new left bundle branch block or a true posterior MI pattern), thrombolytics may be administered or primary<unk>  angioplasty may be performed. In the former, medication is injected that stimulates fibrinolysis, destroying blood clots obstructing the<unk>  arteries. In the latter, a flexible catheter is passed via the femoral or radial arteries and advanced to the heart to identify blockages in the<unk> es. When occlusions are found, they can be intervened upon mechanically with angioplasty and usually stent deployment if a lesion, termed the culprit lesion, is thought to be causing myocardial damage. Data suggest that rapid triage, transfer and treatment is essential. The time frame for door-to-needle thrombolytic administration according to American College of Cardiology (ACC) guidelines should be within 30 minutes, whereas the door-to-balloon Percutaneous<unk>  Intervention (PCI) time should be less than 90 minutes. It was found that thrombolysis is more likely to be delivered within the established ACC guidelines among patients with STEMI as compared to PCI according to a case control study. NSTEMI and NSTE-ACS If the ECG does not show typical changes, the term "non-ST segment elevation<unk> " is applied. The patient may still have suffered a "non-ST elevation MI" (NSTEMI). The accepted management of unstable angina and<unk>  is therefore empirical treatment with aspirin, a second platelet inhibitor such as clopidogrel, prasugrel or ticagrelor, and heparin (usually a low-molecular weight heparin), with intravenous nitroglycerin and opioids if the pain persists. The heparin-like drug known as fondaparinux appears to be better than enoxaparin. A blood test is generally performed for cardiac troponins twelve hours after onset of the pain. If this is positive,<unk>  angiography is typically performed on an urgent basis, as this is highly predictive of a heart attack in the near-future. If the troponin is negative, a treadmill exercise test or a thallium scintigram may be requested. If there is no evidence of ST segment elevation on the electrocardiogram, delaying urgent angioplasty until the next morning is not inferior to doing so immediately. Using statins in the first 14 days after<unk>  reduces the risk of further<unk> . In a cohort study comparing NSTEMI and STEMI, people with NSTEMI had a similar risk of death at one year after PCI as compared to people with STEMI (3.4% vs 4.4%). However, NSTEMI had significantly more "major cardiac events" (death, myocardial infarction, disabling stroke, or requiring revascularization) at one year (24.0% vs 16.6%). Cocaine-associated<unk>  should be managed in a manner similar to other patients with<unk>  except beta blockers should not be used and benzodiazepines should be administered early.
Acute coronary syndrome
Costochondritis
Acute chest syndrome
Bornholm disease
Wooden chest syndrome
Digoxin toxicity
Acute pericarditis
Unstable angina