[Revised Dutch College of General Practitioners' practice guideline 'Acute coronary syndrome']

The practice guideline 'Acute coronary syndrome' gives the general practitioner (GP) guidance on the diagnosis, treatment and long-term management of adults with (experienced) acute coronary syndrome (ACS). Not every patient with ACS presents with chest pain as the main symptom. The GP should evaluate every sign and symptom that may indicate ACS in the same way in both men and women. In patients with ACS the GP should immediately call an ambulance and the patient should be given oral salicylic acid 160-320 mg. If there is chest pain, sublingual nitroglycerine spray is indicated, if necessary followed by intravenous morphine or fentanyl. A normal ECG does not exclude ACS. Patients who have had symptoms indicative of ACS for less than 12 hours, and whose ECG shows abnormalities consistent with myocardial infarction with ST elevation should be referred to a cardiological intervention centre for percutaneous coronary intervention without delay whatever age they are. Patients who have symptoms indicative of ACS but who do not fulfil the above criteria may be given an emergency referral to a general hospital.