STEMI

• Aspirin, Clopidogrel, Atorvastatin, Tenecteplase, Streptokinase (only if nothing else), Enoxaparin, Nitroglycerin sublingual, Morphine (severe pain), Metoprolol (no heart failure / shock), Ramipril, Pantoprazole (with dual antiplatelets)

• Reperfusion: Primary PCI within 120 min of diagnosis; if not possible, lysis within 10 min, then angiography 2–24 h later (ICMR STW 2026; ESC 2023; ACC/AHA 2025)

ECG within 10 minutes; do not wait for troponin to start reperfusion.

First visit

• 12-lead ECG — Within 10 minutes of arrival; repeat every 15–30 min if the first is not diagnostic.
• Troponin (hs-cTn) — Baseline; do not delay reperfusion for the result.
• CBC, creatinine, electrolytes, blood glucose — Before lysis or PCI.

Only if indicated

• Echocardiography — Shock, murmur or uncertain diagnosis.
• Chest X-ray — Breathlessness or suspected aortic dissection.
• Lipid profile and HbA1c — Within 24 h of admission.

Follow-up and monitoring

• ECG at 60–90 minutes after lysis — ST resolution under 50% means failed lysis — rescue PCI.