Cardiac Emergencies: First-Hour Prioritization

A 67-year-old patient develops sudden crushing chest pressure radiating to the left arm, with diaphoresis, nausea and dyspnoea. Blood pressure is 86/54 mmHg, heart rate is 118/min and SpO₂ is 91% on room air. The 12-lead ECG shows ST-segment elevation in leads II, III and aVF. This picture is a possible inferior ST-elevation myocardial infarction (STEMI) with haemodynamic instability. The first-hour priority is to recognize it, activate the emergency cardiac response, start continuous cardiac monitoring, establish IV access and prepare for urgent reperfusion. Before giving any medication that lowers preload, assess for right ventricular (RV) involvement. Do not delay escalation while waiting for a troponin result: an ECG that already shows ST elevation is the diagnosis that triggers action. Cardiac emergencies are acute cardiovascular conditions that threaten myocardial perfusion, cardiac output, electrical stability or systemic circulation. They fall into eight groups: - Acute coronary syndrome (ACS). - Life-threatening dysrhythmias. - Cardiogenic shock. - Cardiac tamponade. - Acute aortic dissection. - Acute decompensated heart failure with pulmonary oedema. - Cardiac arrest. - Mechanical complications of myocardial infarction. Early recognition and rapid...