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Use Risk Scores Wisely
- Use validated risk scores like GRACE to assess ACS prognosis and guide management.
- Only apply risk scores after clinical suspicion of ACS is established from history and exam.
Get ECGs Early and Thorough
- Perform a 12-lead ECG within 10 minutes of patient contact for early ACS diagnosis.
- Use serial and modified lead ECGs (V7-V9, V4R) to detect posterior and right ventricular MIs.
LBBB Needs Clinical Judgment
- Treat patients with left bundle branch block and high suspicion of ischemia as STEMI regardless of whether the block is new or old.
- Use clinical judgment rather than relying solely on ECG changes in LBBB.


