Critical decision making in the management of patients with acute myocardial infarction and other acute coronary syndromes

Optimal management of the patient with possible acute coronary syndrome centers on a series of key decisions. After the need for initial resuscitation is assessed and the patient is stabilized, other questions arise. Is there an acute cardiovascular condition requiring time-dependent treatment? If so, how should disposition be determined with regard to admission decision, level of care, and testing to unmask underlying myocardium at risk? Finally, who should make these decisions? This discussion offers examples of existent institutional diagnosis and treatment pathways.