👤 By the CinnaEMS Content Team🕐 Updated 2026-09-27🏷️ Secondary Assessment🔖 Free to read, print, and share
Also known as: ACS · heart attack · MI · STEMI · angina · chest pain · 12-lead · OPQRST
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Use this quick-reference guide to recognise, treat and hand over Chest Pain & ACS on the NREMT and on the call. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Recognize
Pressure spreading to arm, jaw
Atypical: women, elderly, diabetics
✅ First Steps
12-lead within 10 min
Rest — no walking
O₂ only if hypoxic
🧪 Meds Check
Aspirin: no allergy, no bleeding
Nitro: no low BP, no ED drug
📚 Chest Pain & ACS — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what changes the plan, and what to hand over.
Chest pain is treated as a heart attack until proven otherwise. The exam checks the classic and atypical pictures, the early 12-lead ECG and the checks before aspirin or nitroglycerin are given.
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Key points
Understand these first
Classic ACS: pressure or squeezing that may spread to the arm, jaw or back, with sweating.
Women, older adults and diabetic patients often have atypical signs: fatigue, nausea, dyspnea.
Acquire a 12-lead ECG within 10 minutes of patient contact when available.
Aspirin (chewed) if no allergy or active bleeding, per scope and protocol.
Nitroglycerin is withheld with low blood pressure or an erectile dysfunction drug within 24–48 hours.
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Treatment priorities
What to do, in order
Rest the patient — no walking to the ambulance.
Oxygen only for low saturation (hypoxia) or signs of respiratory distress — not routinely.
Be ready for cardiac arrest: AED close at hand.
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Red flags — report now
Escalate immediately
Tearing pain to the back with unequal arm pulses (aortic dissection)
Chest pain with low blood pressure or a slow pulse
Silent MI presenting as weakness or confusion
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Patient teaching
What patients must know
Relief with nitroglycerin does not rule out a heart attack.
❓ Chest Pain & ACS: NREMT FAQs
What are the priority actions for Chest Pain & ACS in the field?
Rest the patient — no walking to the ambulance. Oxygen only for low saturation (hypoxia) or signs of respiratory distress — not routinely. Be ready for cardiac arrest: AED close at hand.
What findings in Chest Pain & ACS change your plan or your transport decision?
Tearing pain to the back with unequal arm pulses (aortic dissection). Chest pain with low blood pressure or a slow pulse. Silent MI presenting as weakness or confusion.
What do I need to know about Chest Pain & ACS for the NREMT?
Classic ACS: pressure or squeezing that may spread to the arm, jaw or back, with sweating. Women, older adults and diabetic patients often have atypical signs: fatigue, nausea, dyspnea. Acquire a 12-lead ECG within 10 minutes of patient contact when available. Aspirin (chewed) if no allergy or active bleeding, per scope and protocol.
What should the crew communicate or document for Chest Pain & ACS?
Relief with nitroglycerin does not rule out a heart attack.
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Quick Tip
Classic ACS: pressure or squeezing that may spread to the arm, jaw or back, with sweating.