[Chest pain, acute dyspnea, palpitations: internistic emergencies mandate prompt and appropriate action].

Patients with thoracic pain, acute dyspnea and palpitations represent an acute emergency for the general physician. In every case, initial information is provided by an ECG obtained immediately. Ifa suspected acute coronary syndrome is confirmed, continuous ECG rhythm monitoring must be performed. In addition, oxygen must be administered, the patient placed in an appropriate position, and analgesics and antiplatelet medication given. In the event of pulmonary edema, too, initial measures must include oxygen administration, appropriate positioning, administration of a rapid-acting loop diuretic and, where indicated, nitroglycerin. Should tachycardic arrhythmia occur, the width of the ventricular complex must be measured in the ECG before deciding on further treatment. In the out-of-hospital setting, no more than one antiarrhythmic should be given.