Chest pain in the emergency department: suspected acute coronary syndrome

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Educational simulation. Not for real patient care and not a substitute for supervised training. Always follow local protocols.

What you will practise

Recognise the typical and atypical presentations of acute coronary syndrome and prioritise an early 12-lead ECG.
Interpret an ECG showing ST-segment elevation and identify the territory involved.
Prioritise reperfusion over waiting for biomarker results in a patient with ST-elevation myocardial infarction.
Explain the role of antiplatelet therapy and the reasons to avoid NSAIDs in acute myocardial infarction.
Describe the immediate management of ventricular fibrillation complicating myocardial infarction.
Outline secondary prevention after myocardial infarction.

A patient stable on simvastatin is given clarithromycin and develops severe myalgia and dark urine. Which mechanism best explains this?
A patient with severe bradycardia and hypotension after a beta-blocker overdose does not respond to atropine. Which agent bypasses the blocked receptor and increases cAMP in cardiac cells?
Which calcium-channel blocker, when combined with a beta-blocker, carries the greatest risk of severe bradycardia and atrioventricular block?
Which antiarrhythmic class, represented by flecainide, is contraindicated in patients with structural heart disease such as prior myocardial infarction because of increased mortality?
Which statement correctly describes statins?