Date Published

March 30, 2022

Updated For

ALS PCS Version ALS PCS Version 5.2


Hello, How would you like us to proceed with a young pt (say under 30) who complains of chest pain and describes it as ischemic pain, saying all the right things ex; pressure, heaviness etc. But who is vitally stable and doesnt not appear to be in any distress or severe pain. Would you still like us to treat it as ischemia on the side of caution even though its most likely anxiety/stess etc ?


The indication for utilizing the Cardiac Ischemia Medical Directive is Suspected Cardiac Ischemia and age greater than and equal to 18 are conditions for this directive to be applied. Therefore, if you are suspecting cardiac ischemia, you may treat under this directive. People under the age of 30 can experience acute coronary syndrome (angina, NSTEMI, STEMI). Age should not rule out this diagnosis.

A word of caution regarding chalking a patients symptoms up to anxiety/stress: Although uncommon, young people can have cardiac ischemia or other serious medical causes (i.e. spontaneous pneumothorax) as the cause for their symptoms. Remain vigilant, perform a thorough history and physical and keep the list of not to miss causes on your differential.



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