A 58-year-old man presents with substernal chest pain lasting 45 minutes, diaphoresis, and shortness of breath. What is the most appropriate initial management step?

A 58-year-old man presents with substernal chest pain lasting 45 minutes, diaphoresis, and shortness of breath. What is the most appropriate initial management step?

• A. Administer a single dose of morphine for pain relief.
• B. Obtain an urgent 12-lead ECG and serial troponins, start aspirin if not contraindicated, and activate ACS protocol while preparing for reperfusion if indicated.
• C. Schedule a stress test for next week.
• D. Discharge home with patient education and NSAIDs.

Answer: (B)