Acute Coronary Syndromes in ACLS: Recognition and First Steps

Many cardiac arrests start with an acute coronary syndrome, and the fastest way to prevent them is early recognition and reperfusion. ACS is one of the core cases on the ACLS course.

Recognising ACS

Chest pressure or pain, often spreading to the arm, jaw or back, with breathlessness, sweating or nausea. Women, older adults and people with diabetes may have atypical symptoms.

The 12-lead ECG

Obtain a 12-lead ECG within minutes of arrival and read it for ST elevation. STEMI changes the urgency completely. See ACLS rhythms for the monitoring side.

Early treatment

• Aspirin, unless contraindicated.
• Oxygen only if the patient is hypoxaemic or breathless.
• Nitroglycerin for ongoing pain, unless contraindicated — for example low blood pressure or recent use of certain erectile dysfunction drugs.
• Pain relief as appropriate.

See ACLS drugs.

Reperfusion

For STEMI, primary PCI in a cath lab is preferred when it can be done promptly; fibrinolysis is an option when it cannot. Time targets are taught on the course.

If the patient arrests

VF is common in the early hours of a heart attack — see the shockable pathway — and coronary thrombosis is one of the T’s. After ROSC, a coronary cause is assessed as part of post-arrest care.

This guide summarises what the ACLS course teaches for education only. It is not a clinical protocol: follow the current American Heart Association guidelines, linked below, and your institution’s policies.

More ACLS guides: ACLS algorithms and skills

• ACLS Course in Abu Dhabi — dates, format and booking
• ACLS Algorithms Explained: Cardiac Arrest, Bradycardia, Tachycardia and Post-Arrest Care
• The ACLS Systematic Approach: BLS, Primary and Secondary Assessment
• ACLS Cardiac Arrest: VF and Pulseless VT (the Shockable Pathway)
• ACLS Asystole and PEA: The Non-Shockable Pathway
• ACLS Bradycardia Algorithm: Atropine, Pacing and Infusions
• ACLS Tachycardia Algorithm: Stable vs Unstable Tachycardia
• ACLS Post-Cardiac Arrest Care: What Happens After ROSC
• The H's and T's of ACLS: Reversible Causes of Cardiac Arrest
• ACLS Drugs: Adrenaline, Amiodarone, Atropine, Adenosine and More
• ACLS Rhythms: The ECG Rhythms You Need to Recognise
• ACLS Airway Management: From Bag-Mask to Advanced Airway
• Waveform Capnography in ACLS: What End-Tidal CO2 Tells You
• Acute Stroke in ACLS: Recognition, Timing and First Steps
• ACLS Megacode: How It Works and How to Pass as Team Leader
• ACLS Electrical Therapy: Defibrillation, Cardioversion and Pacing
• All ACLS guides, by topic

Other life support and first aid courses: BLS Course · PALS Course · First Aid Course · Training calendar

Frequently asked questions

What is the first test for suspected ACS?

A 12-lead ECG, obtained quickly.

Is aspirin given in ACS?

Yes, unless contraindicated.

Should all ACS patients get oxygen?

No, only if they are hypoxaemic or breathless.

What is the preferred reperfusion for STEMI?

Primary PCI when available promptly; fibrinolysis otherwise.

Is ACS part of ACLS?

Yes, it is one of the core cases.

Sources and further reading

What we teach follows the awarding body and the UAE health authorities. For the definitive position on a course or licensing question, these are the places to check.

• CPR and ECC Guidelines — American Heart Association
• Advanced Cardiovascular Life Support (ACLS) — American Heart Association

Last reviewed 21 September 2026 by the training team at Safety First Medical Services, an American Heart Association training centre at Addax Office Tower, Al Reem Island, Abu Dhabi. Call +971 55 761 9841 or email training@safetyfirstmed.ae.