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Nursing care in acute coronary syndrome: chest pain, the first hour, the ward and secondary prevention

  • Safe practice

Chest pain is an emergency until proven otherwise: call for help, get a 12-lead ECG within 10 minutes, monitor, and give ordered medicines with their checks.

Updated

What it is

In acute coronary syndrome the nurse is often the first to see the pain. The job is to recognise it, including the less typical forms, raise the alarm, obtain a 12-lead ECG within the first 10 minutes, start monitoring and prepare the treatment the team orders. On the ward the nurse reassesses pain and vital signs, repeats the ECG when the pain comes back, watches for rhythm problems and bleeding, and checks before each nitrate, beta blocker or antiplatelet. Before discharge the nurse teaches the warning signs, what to do if pain returns, the medicines that must not be stopped and cardiac rehabilitation. The disease is explained on the condition pages.

What it requires

  • Fast recognition and escalation: the earlier treatment starts, the less heart muscle is lost.
  • A 12-lead ECG within 10 minutes and cardiac monitoring as the protocol sets.
  • Pain, vital signs, saturation and rhythm reassessed often; oxygen according to the order and the saturation.
  • Checks before each cardiac medicine and watching for bleeding when antithrombotic drugs are used.
  • Teaching for secondary prevention: medicines, risk factors, activity and cardiac rehabilitation.

How it is applied (and why)

  1. Stop the activity, keep the patient at rest and call for help as the protocol sets — rest lowers the heart's oxygen demand.
  2. Obtain a 12-lead ECG within 10 minutes and hand it over at once — ST changes need an urgent medical decision.
  3. Attach the cardiac monitor and measure blood pressure, pulse, breathing and saturation — rhythm problems and low pressure appear early.
  4. Assess the pain: site, spread, character, intensity and onset time — gives a baseline and the time window for treatment.
  5. Prepare what the protocol sets and the medicines ordered — the team can act without delay.
  6. Before a nitrate, check blood pressure and ask about erectile-dysfunction medicines; the patient sits — nitrates can drop pressure sharply.
  7. Repeat the ECG and inform the doctor if pain returns or changes — new pain can mean new ischaemia.
  8. Watch the puncture sites, urine, stools and gums when antithrombotics are used — they raise the risk of bleeding.
  9. Before discharge, teach warning signs, the medicine plan, risk-factor control and rehabilitation; check teach-back — prevents another event.

In nursing practice

  • Call at once for chest pain that does not settle with rest or ordered treatment, or that comes back.
  • Call for a new irregular rhythm, a very slow or very fast pulse, or a monitor alarm with a change in the patient.
  • Call for low blood pressure, cold sweaty skin, confusion, fainting or new breathlessness.
  • Call for bleeding, black stools, blood in the urine or a sudden severe headache in a patient on antithrombotics.
  • If the patient becomes unresponsive and has no normal breathing, start the institution's cardiac-arrest response.

Common mistakes

  • Taking chest pain in a woman or a person with diabetes less seriously because it is not typical.
  • Delaying the ECG until the doctor arrives.
  • Giving a nitrate without checking blood pressure or asking about erectile-dysfunction medicines.
  • Not repeating the ECG when the pain comes back.
  • Discharging without teaching what to do if the pain returns.

Test yourself

Think of the answer, then tap the question to see it.

How soon should the 12-lead ECG be taken in suspected acute coronary syndrome?

Within the first 10 minutes of arrival, and repeated every 15–30 minutes while symptoms persist.

Which less typical symptoms can a heart attack cause?

Unusual tiredness, nausea or vomiting, breathlessness, or pain in the jaw, neck, back or upper abdomen, more often in women.

What does the nurse check before a nitrate?

Blood pressure, with the patient sitting, and whether an erectile-dysfunction medicine was taken recently, because the combination can drop pressure dangerously.

What should the patient know about antiplatelets at discharge?

That they must not be stopped without the prescriber, that bleeding must be reported, and that all dentists and doctors must be told about them.

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Heart Attack Symptoms, Risk, and Recovery (Centers for Disease Control and Prevention (CDC), 2024); Ricaurte-Carmona C, Saldarriaga-Saldarriaga CA. Diagnóstico del síndrome coronario agudo en primer nivel de atención en Colombia. Iatreia 35(4):433-446 (Iatreia, Universidad de Antioquia (open access), 2022); Nursing Pharmacology, 6.8 Antianginal: Nitrates (Open RN (Chippewa Valley Technical College), LibreTexts, 2020); Heart attack - discharge: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026).

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