765:
786:
224:
341:
176:) they are considered to have a non-ST-elevation myocardial infarction (NSTEMI); otherwise they are classified with unstable angina. Their management is based on the estimation of their risk for adverse events. Patients at low risk can be adequately treated with medical therapy, in many ways similar to the one used for STEMI (but excluding thrombolytics). Those at moderate to high risk benefit from an early invasive strategy, which includes
3978:
4008:
910:. In most cases, the advice is a gradual increase in physical exercise during about 6–8 weeks following an MI. If it doesn't feel too hard for the patient, the advice about exercise is then the same as applies to anyone else to gain health benefits, that is, at least 20–30 minutes of moderate exercise on most days (at least five days per week) to the extent of getting slightly short of breath.
4018:
965:. The suspicion or provisional diagnosis of an MI means that it is inappropriate for the patient to walk out of the wilderness setting and will require them to be carried or conveyed in a vehicle. Aspirin, nitroglycerin, and oxygen can all be given with relative ease in a wilderness setting and should be administered as soon as possible in suspected cases of MI. Wilderness management of
437:, dilate blood vessels, which is beneficial against myocardial ischemia in two ways: By increasing blood flow in the coronary arteries and the amount of oxygen that arrives to heart muscle; and by relaxing all blood vessels in the body, thereby reducing the workload that heart needs to produce against them and the oxygen it consumes. The preferred mode of administration is
3998:
3988:
1476:"ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction)"
159:). Patients with acute coronary syndrome and ST elevation are said to have ST-elevation myocardial infarction (STEMI) and they tend to have one of their coronary arteries totally blocked. Damage is reversible for approximately 20-30 minutes after complete obstruction of blood flow; thereafter myocardial
147:
Acute coronary syndromes are caused by sudden and critical reduction of blood flow in one of the coronary arteries, the vessels that supply oxygenated blood to the myocardium (heart muscle), typically by a blood clot. The principal symptom is typically chest pain, known as angina pectoris; people who
854:
At least 10% of patients with STEMI do not develop myocardial necrosis (as evidenced by a rise in cardiac markers) and subsequent Q waves on EKG after reperfusion therapy. Such a successful restoration of flow to the infarct-related artery during an acute myocardial infarction is known as "aborting"
326:
in the field and using this information to triage the patient to the most appropriate medical facility. In addition, the 12-lead ECG can be transmitted to the receiving hospital, which enables time saving decisions to be made prior to the arrival of the patient. This may include a "cardiac alert" or
846:
to determine if there is significant ischemia that would benefit from revascularization. If hemodynamic instability develops in individuals with NSTEMIs, they may undergo urgent coronary angiography and subsequent revascularization. The use of thrombolytic agents is contraindicated in this patient
2662:
Waldo AL, Camm AJ, deRuyter H, Friedman PL, MacNeil DJ, Pauls JF, Pitt B, Pratt CM, Schwartz PJ, Veltri EP (1996). "Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. The SWORD Investigators. Survival With Oral d-Sotalol".
587:
in patients with STEMI and in patients presenting without ST elevation. Aspirin is contraindicated in patients with documented allergy or known platelet disorder. Patients who have had gastrointestinal symptoms while on long-term aspirin therapy are usually able to tolerate aspirin in the short
525:
Initial administration of oxygen to all patients with acute coronary syndrome is common practice; however, there is no evidence to support or refute that supplemental oxygen might be harmful or beneficial for cardiac patients who do not need it. It is currently recommended to give oxygen only to
645:
or aged 75 years or older. In patients with non-ST elevation acute coronary syndrome current guidelines also recommend immediate administration of dual antiplatelet therapy upon diagnosis; clopidogrel and ticagrelor are indicated in this setting, with ticagrelor considered superior for patients
282:
Emergency
Medical Services (EMS) Systems vary considerably in their ability to evaluate and treat patients with suspected acute myocardial infarction. Some provide as little as first aid and early defibrillation. Others employ highly trained paramedics with sophisticated technology and advanced
850:
The basis for this distinction in treatment regimens is that ST segment elevations on an ECG are typically due to complete occlusion of a coronary artery. On the other hand, in NSTEMIs there is typically a sudden narrowing of a coronary artery with preserved (but diminished) flow to the distal
163:
ensues and progresses as time passes. Therefore, complete and sustained restoration of blood flow must be as prompt as possible to ensure maximum salvage of functional myocardium, a principle expressed in the maxim "time is muscle". This is achieved with reperfusion therapy, which is based on
269:
Patients should not be transported to hospital by private vehicles instead of an ambulance, unless evacuation by land or air ambulance is impossible (e.g., dangerous weather in a very remote area), and if they must be, it should be done if possible with someone trained in cardiac first aid.
802:
The concept of reperfusion has become so central to the modern treatment of acute myocardial infarction, that we are said to be in the reperfusion era. Patients who present with suspected acute myocardial infarction and ST segment elevation (STEMI) or new bundle branch block on the 12 lead
2544:
Fibrinolytictherapytrialistsf (February 1994). "Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic
Therapy Trialists' (FTT)
745:(APTT). In STEMI patients choice depends on the reperfusion strategy used (see below); bivalirudin is used when PCI is employed only, while in the same case fondaparinux is not preferred. Similarly, in Non-STE ACS bivalirudin too is only used when an early invasive strategy is chosen.
299:. Some advanced paramedic systems can also perform 12-lead ECGs. If a STEMI is recognized the paramedic may be able to contact the local PCI hospital and alert the emergency room physician, and staff of the suspected AMI. Some Paramedic services are capable of providing
785:
2707:
384:
are routinely obtained and their elevation is necessary for confirming diagnosis of myocardial infarction; however, reperfusion must not be delayed by waiting for the results. Patients without the above findings are initially classified with non ST elevation
550:
parameters and cardiac oxygen consumption. However, in patients presenting without ST elevation, morphine has been shown to have adverse events potential, and its use is considered acceptable only after inadequate pain relief by medication specific against
191:
Medical therapy for acute coronary syndromes is based on drugs that act against ischemia and resultant angina and limit the infarct size (i.e., the area of myocardium that is affected), as well as drugs that inhibit clot formation. The latter include
28:
1663:
Moyer P, Feldman J, Levine J, et al. (June 2004). "Implications of the
Mechanical (PCI) vs Thrombolytic Controversy for ST Segment Elevation Myocardial Infarction on the Organization of Emergency Medical Services: The Boston EMS Experience".
822:
Individuals without ST segment elevation are presumed to be experiencing either unstable angina (UA) or non-ST segment elevation myocardial infarction (NSTEMI). They receive many of the same initial therapies and are often stabilized with
546:, which is considered the analgesic of choice in patients with ST elevation. Along with its pain-controlling properties, morphine also reduces the work of breathing, alleviates breathlessness, reduces anxiety and has favorable action on
265:
Patients should stay calmed in a comfortable position. In case of heart attack, it would not usually be lying down, but sitting down or sitting down with folded knees (but patients would notice the possition that fits for them).
273:
Health care professionals are responsible for teaching their patients at risk of acute coronary syndrome what the symptoms of this condition are, and that it is imperative to seek urgent medical attention in case they present.
171:
Patients without ST segment elevation are said to have non-ST-elevation acute coronary syndrome and tend not to have full occlusion of a coronary artery. If there is evidence of myocardial cell death (especially elevated
903:. Some patients become afraid of exercising because it might trigger another infarct. Patients are encouraged to exercise, and should only avoid certain exerting activities. Local authorities may place limitations on
969:
differs slightly from that carried out in an urban setting in that it is generally considered acceptable to terminate a resuscitation attempt after 30 minutes if there has been no change in the patient's condition.
673:, or perhaps before. Administering eptifibatide or tirofiban may also be reasonable in patients presenting with NST-ACS who are considered of intermediate or high risk and are treated with early invasive strategy.
636:
ticagrelor and prasugrel are considered superior to clopidogrel, as they are more potent and have more rapid onset of action, at the cost of some increase in bleeding risk; for STEMI patients who are treated with
3129:"2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines"
1392:
Imamura, Teruhiko; Hori, Masakazu; Koi, Takatoshi; Fukui, Takuya; Oshima, Akira; Fujioka, Hayato; Ueno, Yohei; Onoda, Hiroshi; Tanaka, Shuhei; Fukuda, Nobuyuki; Ueno, Hiroshi; Kinugawa, Koichiro (2022-01-07).
1743:"ST-segment elevation myocardial infarction: recommendations on triage of patients to heart attack centers: is it time for a national policy for the treatment of ST-segment elevation myocardial infarction?"
331:
is not staffed 24 hours a day. Even in the absence of a formal alerting program, prehospital 12-lead ECGs are independently associated with reduced door to treatment intervals in the emergency department.
2708:"Randomised trial of effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT. European Myocardial Infarct Amiodarone Trial Investigators"
360:
In patients with symptoms typical of myocardial ischemia an electrocardiogram must be immediately obtained - e.g., within 10 minutes from first contact with medical or paramedical personnel, including
2859:"Management of cocaine-associated chest pain and myocardial infarction: a scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology"
1540:"Evaluation of the time saved by prehospital initiation of reteplase for ST-elevation myocardial infarction: results of The Early Retavase-Thrombolysis in Myocardial Infarction (ER-TIMI) 19 trial"
941:
should be administered early. The treatment itself may have complications. If attempts to restore the blood flow are initiated after a critical period of only a few hours, the result may be a
764:
681:
Anticoagulants in acute coronary syndrome are targeted against the coronary blood clot, as well as towards prevention of thrombotic complications, like formation of blood clots in the
413:
and increases the workload of the heart. The pain of myocardial ischemia is likely to respond to any intervention that improves the relationship between oxygen demand and supply, like
1701:"Reduction of treatment delay in patients with ST-elevation myocardial infarction: impact of pre-hospital diagnosis and direct referral to primary percutanous coronary intervention"
151:
Acute coronary syndromes are classified to two major categories, according to the patient's electrocardiogram, and specifically the presence or absence of persistent (>20 min)
235:
Because of the relationship between the duration of myocardial ischemia and the extent of damage to heart muscle, public health services encourage people experiencing possible
1085:
Antman EM (2012a). "Chapter 54. ST-segment elevation myocardial infarction: Pathology, pathophysiology, and clinical features". In Bonow RO, Mann DL, Zipes DP, Libby P (eds.).
628:
receptor, on the surface of platelets. Not all three of them are equally indicated in all types of acute coronary syndromes. In patients with ST elevation the choice of P2Y
777:; arrow points at partial occlusion of left circumflex coronary artery; star indicates tip of the guide wire that has been inserted in the artery through the occlusion.
2505:"Predictors of in-hospital and 6-month outcome after acute myocardial infarction in the reperfusion era: the Primary Angioplasty in Myocardial Infarction (PAMI) trail"
164:
invasive reopening of the affected coronary artery with primary percutaneous coronary intervention, or non-invasive breaking up of the responsible blood clot with a
646:
undergoing early invasive strategy (see later). However, emerging evidence questions this strategy. As with aspirin, it is necessary to administer a loading dose.
489:, and hence heart oxygen consumption. Beta-blockers alleviate ischemic pain, and have also been proved to reduce the size of infarcted heart muscle, the risk of
517:); in the absence of contraindications beta blocker therapy should begin in the first 24 hours. It may be prudent to prefer oral rather than intravenous forms.
1579:
Morrison LJ, Verbeek PR, McDonald AC, Sawadsky BV, Cook DJ (2000). "Mortality and prehospital thrombolysis for acute myocardial infarction: A meta-analysis".
365:
356:
I, aVL and V1-V5 indicates an anterior wall myocardial infarction and is shown in orange; reciprocal ST depression in leads II, III and aVF is shown in blue.
91:, the vessels that supply oxygenated blood to the myocardium. This is achieved with urgent hospitalization and medical therapy, including drugs that relieve
917:
after a heart attack. Most people can resume sexual activities after 3 to 4 weeks. The amount of activity needs to be dosed to the patient's possibilities.
3184:
Cannon, CP; Braunwald, E (2012). "Chapter 56. Unstable angina and non-ST elevation myocardial infarction". In Bonow RO; Mann DL; Zipes DP; Libby P (eds.).
669:. Patients presenting with ST elevation that will be reperfused with percutaneous coronary intervention may receive one of the above agents at the time of
3507:
871:. Antiarrhythmic agents are typically only given to individuals with life-threatening arrhythmias after a myocardial infarction and not to suppress the
3848:
228:
3165:
Antman, EM; Morrow DA (2012b). "Chapter 55. ST-segment elevation myocardial infarction: Management". In Bonow RO; Mann DL; Zipes DP; Libby P (eds.).
2816:
2759:
807:
are presumed to have an occlusive thrombosis in an epicardial coronary artery. They are therefore candidates for immediate reperfusion, either with
493:, and the proportion of patients with acute coronary syndrome who actually evolve STEMI. However, they have also been shown to increase the risk of
254:
should promptly take one dose, and call emergency medical services if their symptoms do not improve within 2–5 minutes. Chewing non−enteric-coated
3447:
1517:
583:
aggregation and formation of blood clots. It is effective across the entire spectrum of acute coronary syndromes; it has been shown to reduce the
390:
3193:
3174:
2844:
2272:"Reappraisal of thienopyridine pretreatment in patients with non-ST elevation acute coronary syndrome: a systematic review and meta-analysis"
2207:
2155:
1814:
1145:
1120:
1094:
742:
641:
and those who do not undergo reperfusion treatment only clopidogrel is indicated. Prasugrel must not be given to patients with a history of
3747:
892:
556:
95:
and reduce the size of the infarct, and drugs that inhibit clot formation; for a subset of patients invasive measures are also employed (
2621:
Echt DS, Liebson PR, Mitchell LB, Peters RW, Obias-Manno D, Barker AH, Arensberg D, Baker A, Friedman L, Greene HL, et al. (1991).
4042:
3883:
3225:
983:
812:
774:
633:
377:
307:
100:
1785:
885:
in those affected by a heart disease. This can be with the help of a physician, or in the form of a cardiac rehabilitation program.
872:
494:
4001:
933:
associated myocardial infarction should be managed in a manner similar to other patients with acute coronary syndrome, except that
608:
Aside from aspirin, three antiplatelet agents taken by mouth have been approved for use in acute coronary syndromes, clopidogrel,
4052:
4047:
995:
654:
571:, including aspirin and generally a second oral antiplatelet agent. Bleeding is the most important side-effect of antiplatelets.
3059:"ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation"
1111:
Canty J Jr (2012). "Chapter 52. Coronary blood flow and myocardial ischemia". In Bonow RO, Mann DL, Zipes DP, Libby P (eds.).
3873:
3307:
1395:"Relationship Between Body Posture and Lung Fluid Volume Assessed Using a Novel Noninvasive Remote Dielectric Sensing System"
1049:
1037:
878:
816:
657:
are a class of intravenous antiplatelet agents used in patients undergoing percutaneous coronary intervention, consisting of
405:
Relief of the pain of angina is of paramount importance, not only for humane reasons but because the pain is associated with
185:
863:
Additional objectives are to prevent life-threatening arrhythmias or conduction disturbances. This requires monitoring in a
2623:"Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial"
4057:
3853:
840:
710:
527:
434:
251:
3497:
2755:
4062:
2405:"Relationship between treatment delay and final infarct size in STEMI patients treated with abciximab and primary PCI"
208:). Long-term therapy in acute coronary syndrome survivors is targeted against recurrence and long-term complications (
3128:
2024:"Role of intravenous β-blockers in the treatment of ST-elevation myocardial infarction. Of mice (dogs, pigs) and men"
340:
127:
and non-ST elevation myocardial infarction (NSTEMI). Treatment is generally more aggressive for STEMI patients, and
3477:
3024:"ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation"
1525:
1033:
478:
406:
361:
311:
240:
223:
3906:
730:
3698:
3620:
3615:
3535:
3295:
1204:
Scott, IA (2010). ""Time is muscle" in reperfusing occluded coronary arteries in acute myocardial infarction".
978:
Certified personnel traveling by commercial aircraft may be able to assist an MI patient by using the on-board
836:
498:
461:) within the previous 24–48 hours, as the combination of the two could cause a serious drop in blood pressure.
328:
215:
Women are taken less seriously than men when they have a heart attack leading to higher mortality among women.
156:
2948:
2836:
851:
myocardium. Anticoagulation and antiplatelet agents are given to prevent the narrowed artery from occluding.
3678:
3652:
1783:"The emergency medical systems-to-balloon (E2B) challenge: building on the foundations of the D2B Alliance,"
1029:
734:
670:
386:
247:
236:
136:
104:
3270:
3218:
1006:
are being introduced by some airlines, and they can be used by both on-board and ground-based physicians.
702:
514:
37:
2813:
3921:
3807:
3780:
3753:
3705:
3659:
3354:
1624:"Rationale for establishing regional ST-elevation myocardial infarction receiving center (SRC) networks"
914:
741:). Unfractionated heparin has the disadvantage of requiring dose adjustment based on a laboratory exam,
442:
209:
120:
1514:
895:
after a myocardial infarction, with beneficial effects on cholesterol levels, blood pressure, weight,
3941:
3901:
3768:
3582:
3577:
3557:
3492:
3344:
2772:
954:
868:
791:
Coronary angiography of the same patient, after dilation of the artery with balloon and placement of
770:
694:
458:
319:
177:
152:
108:
96:
1342:
4021:
3963:
3946:
3605:
3322:
843:
754:
738:
625:
462:
353:
128:
4007:
773:
of a patient with acute myocardial infarction presenting with ST elevation and undergoing primary
3911:
3868:
3858:
3647:
3600:
3567:
3562:
3312:
3290:
2735:
2688:
1604:
1303:"Timing is everything. Motivating patients to call 9-1-1 at onset of acute myocardial infarction"
1229:
958:
942:
864:
690:
1367:
3981:
3863:
3833:
3812:
3775:
3758:
3673:
3637:
3627:
3522:
3442:
3386:
3349:
3334:
3275:
3242:
3211:
3189:
3170:
3146:
3115:
3080:
3045:
3000:
2929:
2880:
2727:
2680:
2644:
2603:
2562:
2526:
2485:
2436:
2301:
2203:
2151:
2104:
2086:
2045:
1965:
1853:
1810:
1764:
1722:
1681:
1645:
1596:
1561:
1497:
1432:
1414:
1324:
1221:
1192:
1141:
1116:
1090:
1025:
900:
896:
888:
824:
682:
345:
193:
181:
112:
88:
54:
3683:
3668:
3545:
3420:
3376:
3136:
3105:
3070:
3035:
2990:
2982:
2919:
2911:
2870:
2719:
2672:
2634:
2593:
2554:
2516:
2475:
2467:
2426:
2416:
2291:
2283:
2094:
2078:
2035:
1955:
1843:
1754:
1712:
1673:
1635:
1588:
1551:
1487:
1422:
1406:
1314:
1213:
1182:
1003:
490:
410:
2065:
Cabello, Juan B.; Burls, Amanda; Emparanza, José I.; Bayliss, Susan E.; Quinn, Tom (2016).
855:
the myocardial infarction. If treated within the hour, about 25% of STEMIs can be aborted.
4011:
3956:
3817:
3802:
3785:
3725:
3720:
3664:
3642:
3339:
3285:
3265:
2840:
2820:
2789:
2456:"Predictors of 30-Day Mortality in the Era of Reperfusion for Acute Myocardial Infarction"
1789:
1782:
1521:
1028:, produced by national and international medical societies according to the principles of
938:
882:
718:
466:
394:
315:
124:
41:
1136:
Schoen, FJ (2010). "The heart". In Kumar, V.; Abbas, A.K.; Fausto, N.; Aster, J. (eds.).
441:. By relaxing blood vessels nitrates also reduce blood pressure, which must be carefully
3843:
3797:
3610:
3540:
3359:
2995:
2970:
2924:
2899:
2431:
2404:
2296:
2271:
2099:
2066:
1677:
1427:
1394:
1217:
966:
592:
is recommended. Lower doses need days to achieve full antiplatelet effect, therefore a
584:
486:
454:
422:
381:
288:
173:
2875:
2858:
2723:
2676:
2558:
2040:
2023:
1556:
1539:
4036:
3926:
3715:
3710:
3572:
3512:
3415:
2521:
2504:
979:
907:
828:
482:
418:
201:
2739:
2692:
1608:
107:. However, some important aspects of treatment depend on the presence or absence of
3991:
3931:
3916:
3742:
3467:
3317:
3302:
3248:
2082:
934:
832:
808:
714:
662:
638:
593:
568:
547:
506:
502:
438:
369:
300:
165:
123:(STEMI) or non-ST elevation acute coronary syndrome (NST-ACS); the latter includes
3094:"2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction"
310:
emerging as the preferred therapy for ST-segment elevation myocardial infarction,
131:
is more often reserved for them. Long-term therapy is necessary for prevention of
79:
is targeted against the effects of reduced blood flow to the affected area of the
3141:
3110:
3093:
1830:
Thygesen, K; Alpert, JS; Jaffe, AS; Simoons, ML; Chaitman, BR; White, HD (2012).
1233:
148:
present with angina must prompt evaluation for possible acute coronary syndrome.
3790:
3735:
3632:
3487:
3462:
3280:
2900:"Coronary interventions and their impact on post myocardial infarction survival"
2639:
2622:
726:
589:
510:
446:
205:
3878:
3075:
3058:
3040:
3023:
2706:
Julian DG, Camm AJ, Frangin G, Janse MJ, Munoz A, Schwartz PJ, Simon P (1997).
2598:
2581:
1848:
1831:
1759:
1742:
1717:
1700:
1492:
1475:
1410:
1187:
1170:
27:
3763:
3730:
3502:
3452:
3437:
3432:
3425:
3410:
3400:
2986:
1640:
1623:
706:
609:
450:
349:
116:
80:
45:
33:
2471:
2090:
1592:
1418:
1319:
1302:
1284:
231:
urging people with symptoms of angina to call the emergency medical services.
3951:
3693:
3688:
3552:
3530:
3405:
3369:
1960:
1943:
722:
666:
658:
613:
3150:
3119:
3084:
3049:
3004:
2971:""Is there a doctor on the aircraft?" Top 10 in-flight medical emergencies"
2933:
2915:
2884:
2607:
2440:
2421:
2305:
2108:
2049:
1857:
1768:
1726:
1685:
1649:
1600:
1565:
1501:
1436:
1328:
1225:
1196:
632:
inhibitor depends on reperfusion strategy; for patients undergoing primary
389:, and subsequent cardiac biomarker results will differentiate between true
2731:
2684:
2648:
2566:
2530:
2489:
1969:
322:
to the restoration of coronary artery blood flow) by performing a 12-lead
3457:
3234:
698:
580:
543:
414:
292:
197:
160:
84:
1347:
National
Institutes of Health. National Heart, Lung, and Blood Institute
380:(STEMI) and must undergo reperfusion therapy as soon as possible. Serum
66:
3936:
3396:
3364:
3257:
987:
962:
930:
904:
539:
296:
259:
255:
132:
2287:
2582:"Aborted myocardial infarction: a new target for reperfusion therapy"
2480:
999:
991:
686:
642:
552:
284:
92:
1944:"Use of Sildenafil (Viagra) in Patients With Cardiovascular Disease"
303:
in the prehospital setting, allowing reperfusion of the myocardium.
2270:
Bellemain-Appaix, A; Kerneis, M; O'Connor, SA; et al. (2014).
567:
All patients with acute coronary syndrome must immediately receive
200:(cellular blood components that contribute to clot formation), and
2833:
961:
by the fastest available means, often meaning the initiation of a
839:
with subsequent restoration of blood flow (revascularization), or
792:
617:
339:
327:"STEMI alert" that calls in off duty personnel in areas where the
222:
449:
is present. They must also be avoided in patients who have taken
3186:
Braunwald's heart disease: A textbook of cardiovascular medicine
3167:
Braunwald's heart disease: A textbook of cardiovascular medicine
1699:
Terkelsen CJ, Lassen JF, Nørgaard BL, et al. (April 2005).
1113:
Braunwald's heart disease: A textbook of cardiovascular medicine
1087:
Braunwald's heart disease: A textbook of cardiovascular medicine
697:. Patients undergoing PCI also need an anticoagulant to prevent
373:
103:). Basic principles of management are the same for all types of
3207:
2455:
2834:
Heart Attack: Getting Back Into Your Life After a Heart Attack
2776:
1942:
Cheitlin, MD; Hutter, AM Jr; Brindis, RG; et al. (1999).
1741:
Henry TD, Atkins JM, Cunningham MS, et al. (April 2006).
1288:
804:
323:
3127:
Amsterdam, EA; Wengern, NK; Brindis, RG; et al. (2014).
1474:
Antman EM, Anbe DT, Armstrong PW, et al. (August 2004).
1285:
Heart attack care dangerously unequal for women, study finds
1002:. Pilots may divert the flight to land at a nearby airport.
3203:
2857:
McCord J, Jneid H, Hollander JE, et al. (April 2008).
497:. Their early use is contraindicated if there are signs of
3092:
O'Gara, PT; Kushner, FG; Ascheim, DD; et al. (2013).
2169:
2167:
2148:
1913:
1911:
1909:
1907:
1024:
Current management of acute coronary syndrome is based on
596:
is necessary for patients who are not already on aspirin.
1538:
Morrow DA, Antman EM, Sayah A, et al. (July 2002).
3135:. Published online September 23, 2014 (25): 2354–2394.
3057:
Hamm, CW; Bassand, JP; Agewall, S; et al. (2011).
2150:(2nd ed.). McGraw-Hill Professional. p. 291.
1870:
1868:
283:
protocols. Paramedic services are capable of providing
2403:
Tödt, T; Maret, E; Alfredsson, J; et al. (2012).
1068:
1066:
2202:(8th ed.). Elsevier Saunders. pp. 471–472.
1832:"Third universal definition of myocardial infarction"
1515:
559:
are contraindicated for both categories of patients.
465:
nitrates are useful in patients with hypertension or
115:, which classifies cases upon presentation to either
2503:
Stone GW, Grines CL, Browne KF, et al. (1995).
616:; all reduce platelet aggregation by inhibiting the
588:
term. For patients with true intolerance to aspirin
368:
will guide the subsequent management. Patients with
318:
intervals (the time from presentation to a hospital
3894:
3832:
3593:
3521:
3476:
3385:
3256:
3241:
2792:. Nova Scotia Registry of Regulations. May 24, 2000
2454:Lee KL, Woodlief LH, Topol EJ, et al. (1995).
1622:Rokos IC, Larson DM, Henry TD, et al. (2006).
53:
20:
3022:Steg, PG; James, SK; Atar, D; et al. (2012).
875:that is often seen after a myocardial infarction.
32:Acute coronary syndromes are commonly caused by a
2847:, updated March 2005. Retrieved December 4, 2006.
2790:"Classification of Drivers' Licenses Regulations"
538:Analgesic agents that are most commonly used are
352:elevation myocardial infarction. ST elevation in
2751:
2749:
2067:"Oxygen therapy for acute myocardial infarction"
1528:. Updated January 2007, Retrieved June 29, 2011.
982:, which may contain some cardiac drugs (such as
815:(PCI) or when these therapies are unsuccessful,
196:, which block the activation and aggregation of
3188:(9th ed.). Saunders. pp. 1178–1209.
3169:(9th ed.). Saunders. pp. 1111–1178.
1795:, Issue Two, May 2007. Accessed June 16, 2007.
1138:Robbins and Cotran pathologic basis of disease
1115:(9th ed.). Saunders. pp. 1049–1055.
1089:(9th ed.). Saunders. pp. 1087–1110.
795:. The occlusion has been successfully treated.
505:II or above) or hypotension, along with other
3219:
2814:Patient UK > After a Myocardial Infarction
1175:Journal of the American College of Cardiology
8:
2809:
2807:
2779:, December 2005. Retrieved December 2, 2006.
2580:Verheugt FW, Gersh BJ, Armstrong PW (2006).
1140:(8th ed.). Saunders. pp. 529–587.
2071:The Cochrane Database of Systematic Reviews
1171:"Time is muscle. Translation into practice"
184:with percutaneous coronary intervention or
3508:Reproductive endocrinology and infertility
3253:
3226:
3212:
3204:
2342:
2243:
2185:
2009:
1898:
1449:
1041:
835:) stable, they can be offered either late
48:is blocked, eventually causing cell death.
26:
3849:Bachelor of Medicine, Bachelor of Surgery
3140:
3109:
3074:
3039:
2994:
2923:
2874:
2638:
2597:
2520:
2479:
2430:
2420:
2390:
2354:
2318:
2295:
2231:
2173:
2121:
2098:
2039:
1959:
1886:
1847:
1758:
1716:
1639:
1555:
1491:
1426:
1318:
1186:
1045:
1020:
1018:
239:or those around them to immediately call
229:National Heart, Lung, and Blood Institute
2760:National Heart, Lung and Blood Institute
485:decrease heart rate, blood pressure and
2366:
2225:
1997:
1917:
1461:
1248:
1153:
1014:
2255:
2003:
1929:
1807:Management of acute coronary syndromes
1272:
1260:
391:non ST elevation myocardial infarction
376:) are treated based on guidelines for
17:
2845:American Academy of Family Physicians
2333:, p. 2583-2584, 2587-2588, 2591.
1032:. Examples are the guidelines of the
743:activated partial thromboplastin time
557:Non-steroidal anti-inflammatory drugs
77:Management of acute coronary syndrome
21:Management of acute coronary syndrome
7:
3987:
3748:Physical medicine and rehabilitation
2378:
2330:
2249:
2237:
2146:Hilal-Dandan, R; Brunton, L (2013).
2133:
2015:
1982:
1874:
1072:
1057:
1053:
957:, a possible heart attack justifies
3997:
867:and protocolized administration of
455:phosphodiesterase type 5 inhibitors
62:
3884:Medical Scientist Training Program
1678:10.1097/01.hpc.0000128714.35330.6d
1218:10.5694/j.1326-5377.2010.tb04030.x
813:percutaneous coronary intervention
775:percutaneous coronary intervention
733:); all the above agents are given
634:percutaneous coronary intervention
507:contraindications to beta blockers
378:ST elevation myocardial infarction
227:Information card published by the
219:Patient-dependent initial measures
101:percutaneous coronary intervention
14:
2876:10.1161/CIRCULATIONAHA.107.188950
2041:10.1161/CIRCULATIONAHA.107.707968
4016:
4006:
3996:
3986:
3977:
3976:
2947:Youngwith, Janice (2008-02-06).
784:
763:
655:Glycoprotein IIb/IIIa inhibitors
650:Glycoprotein IIb/IIIa inhibitors
314:can play a key role in reducing
258:is encouraged (unless there are
237:acute coronary syndrome symptoms
4017:
2773:Recovering after a heart attack
913:Some people are afraid to have
44:. Oxygen delivery to a part of
3874:Doctor of Osteopathic Medicine
3308:Oral and maxillofacial surgery
2083:10.1002/14651858.CD007160.pub4
1050:European Society of Cardiology
1038:American College of Cardiology
881:aims to optimize function and
831:. If their condition remains (
186:coronary artery bypass surgery
1:
2762:. Retrieved December 2, 2006.
2724:10.1016/S0140-6736(96)09145-3
2677:10.1016/S0140-6736(96)02149-6
2559:10.1016/s0140-6736(94)91161-4
1557:10.1016/S0735-1097(02)01936-8
1526:Alberta College Of Paramedics
1301:Faxon, D; Lenfant, C (2001).
366:electrocardiographic findings
3854:Bachelor of Medical Sciences
3621:Neurosurgical anesthesiology
3142:10.1161/cir.0000000000000133
3111:10.1161/CIR.0b013e3182742cf6
2522:10.1016/0735-1097(94)00367-Y
1809:. Totowa, NJ: Humana Press.
1805:Cannon, Christopher (1999).
1781:Rokos I. and Bouthillet T.,
711:low molecular weight heparin
701:thrombosis. Options include
526:breathless patients or when
2975:BMJ (Clinical Research Ed.)
2969:Dowdall N (November 2000).
2640:10.1056/NEJM199103213241201
2198:Opie, LH; Garsh BJ (2013).
1169:Antman, Elliott M. (2008).
445:; they must not be used if
370:elevation of the ST segment
336:Initial diagnostic approach
109:elevation of the ST segment
4079:
2949:"Saving hearts in the air"
2898:Faxon DP (November 2005).
2381:, p. 2584-5, 2587-91.
1760:10.1016/j.jacc.2005.05.101
1493:10.1016/j.jacc.2004.07.002
1411:10.1253/circrep.CR-21-0130
1188:10.1016/j.jacc.2008.07.011
1034:American Heart Association
752:
481:stimulation of the heart,
241:emergency medical services
4043:Aging-associated diseases
3972:
2987:10.1136/bmj.321.7272.1336
2756:Life after a Heart Attack
1641:10.1016/j.ahj.2006.06.001
1368:"Heart attack - Symptoms"
945:instead of amelioration.
731:direct thrombin inhibitor
250:who have been prescribed
63:
25:
3808:Transplantation medicine
3699:Clinical neurophysiology
3616:Obstetric anesthesiology
3536:Interventional radiology
3296:Digestive system surgery
3076:10.1093/eurheartj/ehr236
3041:10.1093/eurheartj/ehs215
2599:10.1093/eurheartj/ehi829
2472:10.1161/01.cir.91.6.1659
1849:10.1093/eurheartj/ehs184
1718:10.1093/eurheartj/ehi100
1593:10.1001/jama.283.20.2686
1343:"What is a heart attack"
1320:10.1161/circ.104.11.1210
891:is an important part of
499:congestive heart failure
374:left bundle branch block
287:, IV access, sublingual
157:left bundle branch block
4053:Ischemic heart diseases
4048:Cardiovascular diseases
3679:Intensive care medicine
3653:Mass gathering medicine
3498:Maternal–fetal medicine
1961:10.1161/01.CIR.99.1.168
1372:National Health Service
1030:evidence-based medicine
937:should not be used and
528:blood oxygen saturation
387:acute coronary syndrome
248:coronary artery disease
105:acute coronary syndrome
83:, usually because of a
3271:Cardiothoracic surgery
3063:European Heart Journal
3028:European Heart Journal
2916:10.1002/clc.4960281307
2910:(11 Suppl 1): I38–44.
2545:Collaborative Group".
2422:10.1186/1471-2261-12-9
1836:European Heart Journal
879:Cardiac rehabilitation
703:unfractionated heparin
530:is low, e.g. <90%.
515:atrioventricular block
407:sympathetic activation
357:
232:
38:atherosclerotic plaque
3922:Personalized medicine
3781:Reproductive medicine
3706:Occupational medicine
3660:Evolutionary medicine
2823:Reviewed: 19 May 2010
2409:BMC Cardiovasc Disord
869:antiarrhythmic agents
343:
226:
204:(which attenuate the
121:myocardial infarction
3942:Traditional medicine
3902:Alternative medicine
3769:Addiction psychiatry
3583:Transfusion medicine
3578:Medical microbiology
3493:Gynecologic oncology
3345:Reproductive surgery
3015:Selected cited works
2246:, p. e375, e380
2000:, pp. 1116–1117
1747:J. Am. Coll. Cardiol
1544:J. Am. Coll. Cardiol
1480:J. Am. Coll. Cardiol
955:wilderness first aid
837:coronary angiography
809:thrombolytic therapy
771:Coronary angiography
695:deep vein thrombosis
569:antiplatelet therapy
459:erectile dysfunction
301:thrombolytic therapy
246:Patients with known
210:secondary prevention
202:anticoagulant agents
178:coronary angiography
153:ST segment elevation
97:coronary angiography
4058:Medical emergencies
3964:History of medicine
3947:Veterinary medicine
3754:Preventive medicine
3606:Adolescent medicine
3448:Infectious diseases
2904:Clinical Cardiology
2200:Drugs for the heart
2012:, p. e398-e390
1399:Circulation Reports
1048:) and those of the
984:glyceryl trinitrate
755:Reperfusion therapy
737:(subcutaneously or
626:adenosine phosphate
495:acute heart failure
206:coagulation cascade
194:antiplatelet agents
180:and, if necessary,
129:reperfusion therapy
4063:Cardiac procedures
3912:Molecular oncology
3869:Doctor of Medicine
3859:Master of Medicine
3776:Radiation oncology
3648:Emergency medicine
3601:Addiction medicine
3568:Clinical chemistry
3563:Clinical pathology
3355:Transplant surgery
3313:Orthopedic surgery
3291:Colorectal surgery
2839:2008-07-24 at the
2819:2010-07-22 at the
2345:, p. 377-378.
2022:Bates, ER (2007).
1788:2007-08-09 at the
1666:Crit Pathw Cardiol
1520:2011-10-05 at the
949:Wilderness setting
943:reperfusion injury
873:ventricular ectopy
865:coronary care unit
825:antiplatelet drugs
691:pulmonary embolism
563:Antiplatelet drugs
382:cardiac biomarkers
358:
278:Emergency services
233:
174:cardiac biomarkers
143:General principles
4030:
4029:
3864:Master of Surgery
3828:
3827:
3813:Tropical medicine
3759:Prison healthcare
3674:Hospital medicine
3638:Disaster medicine
3628:Aviation medicine
3443:Hospital medicine
3350:Surgical oncology
3335:Pediatric surgery
3329:
3276:Endocrine surgery
3195:978-0-8089-2436-4
3176:978-0-8089-2436-4
3069:(23): 2999–3054.
3034:(20): 2569–2619.
2951:. Dailyherald.com
2509:J Am Coll Cardiol
2288:10.1136/bmj.g6269
2209:978-1-4557-3322-4
2157:978-0-07-176917-4
2034:(23): 2904–2906.
1842:(20): 2551–2567.
1816:978-0-89603-552-2
1313:(11): 1210–1211.
1181:(15): 1216–1221.
1147:978-1-4160-3121-5
1122:978-0-8089-2436-4
1096:978-0-8089-2436-4
994:painkillers), an
889:Physical exercise
847:subset, however.
579:Aspirin inhibits
542:, and especially
372:(or presumed new
346:electrocardiogram
260:contraindications
182:revascularization
166:thrombolytic drug
113:electrocardiogram
89:coronary arteries
74:
73:
4070:
4020:
4019:
4010:
4000:
3999:
3990:
3989:
3980:
3979:
3684:Medical genetics
3669:General practice
3546:Nuclear medicine
3421:Gastroenterology
3377:Vascular surgery
3327:
3254:
3228:
3221:
3214:
3205:
3199:
3180:
3161:
3159:
3157:
3144:
3123:
3113:
3104:(4): e362–e425.
3088:
3078:
3053:
3043:
3009:
3008:
2998:
2981:(7272): 1336–7.
2966:
2960:
2959:
2957:
2956:
2944:
2938:
2937:
2927:
2895:
2889:
2888:
2878:
2869:(14): 1897–907.
2854:
2848:
2830:
2824:
2811:
2802:
2801:
2799:
2797:
2786:
2780:
2771:Trisha Macnair.
2769:
2763:
2753:
2744:
2743:
2718:(9053): 667–74.
2703:
2697:
2696:
2659:
2653:
2652:
2642:
2618:
2612:
2611:
2601:
2577:
2571:
2570:
2553:(8893): 311–22.
2541:
2535:
2534:
2524:
2500:
2494:
2493:
2483:
2466:(6): 1659–1668.
2451:
2445:
2444:
2434:
2424:
2400:
2394:
2393:, p. 41-43.
2388:
2382:
2376:
2370:
2364:
2358:
2352:
2346:
2340:
2334:
2328:
2322:
2321:, p. 37-40.
2316:
2310:
2309:
2299:
2267:
2261:
2220:
2214:
2213:
2195:
2189:
2183:
2177:
2171:
2162:
2161:
2143:
2137:
2131:
2125:
2119:
2113:
2112:
2102:
2077:(12): CD007160.
2062:
2056:
2053:
2043:
1992:
1986:
1980:
1974:
1973:
1963:
1939:
1933:
1927:
1921:
1915:
1902:
1896:
1890:
1884:
1878:
1872:
1863:
1861:
1851:
1827:
1821:
1820:
1802:
1796:
1779:
1773:
1772:
1762:
1738:
1732:
1730:
1720:
1696:
1690:
1689:
1660:
1654:
1653:
1643:
1619:
1613:
1612:
1576:
1570:
1569:
1559:
1535:
1529:
1512:
1506:
1505:
1495:
1471:
1465:
1459:
1453:
1447:
1441:
1440:
1430:
1389:
1383:
1382:
1380:
1378:
1364:
1358:
1357:
1355:
1353:
1339:
1333:
1332:
1322:
1298:
1292:
1282:
1276:
1270:
1264:
1258:
1252:
1246:
1240:
1237:
1200:
1190:
1163:
1157:
1151:
1133:
1127:
1126:
1108:
1102:
1100:
1082:
1076:
1070:
1061:
1022:
1004:Cardiac monitors
788:
767:
411:vasoconstriction
401:Relief of angina
329:cardiac cath lab
133:recurrent events
67:edit on Wikidata
30:
18:
4078:
4077:
4073:
4072:
4071:
4069:
4068:
4067:
4033:
4032:
4031:
4026:
3968:
3957:Chief physician
3890:
3835:
3824:
3818:Travel medicine
3803:Sports medicine
3786:Sexual medicine
3726:Palliative care
3721:Pain management
3665:Family medicine
3643:Diving medicine
3589:
3517:
3479:
3472:
3388:
3381:
3340:Plastic surgery
3286:General surgery
3266:Cardiac surgery
3247:
3245:
3237:
3232:
3202:
3196:
3183:
3177:
3164:
3155:
3153:
3126:
3091:
3056:
3021:
3017:
3012:
2968:
2967:
2963:
2954:
2952:
2946:
2945:
2941:
2897:
2896:
2892:
2856:
2855:
2851:
2841:Wayback Machine
2831:
2827:
2821:Wayback Machine
2812:
2805:
2795:
2793:
2788:
2787:
2783:
2770:
2766:
2754:
2747:
2705:
2704:
2700:
2661:
2660:
2656:
2620:
2619:
2615:
2579:
2578:
2574:
2543:
2542:
2538:
2502:
2501:
2497:
2453:
2452:
2448:
2402:
2401:
2397:
2389:
2385:
2377:
2373:
2369:, p. 1029.
2365:
2361:
2353:
2349:
2341:
2337:
2329:
2325:
2317:
2313:
2269:
2268:
2264:
2221:
2217:
2210:
2197:
2196:
2192:
2188:, p. e391.
2184:
2180:
2172:
2165:
2158:
2145:
2144:
2140:
2136:, p. 2576.
2132:
2128:
2120:
2116:
2064:
2063:
2059:
2021:
1993:
1989:
1985:, p. 2598.
1981:
1977:
1941:
1940:
1936:
1932:, p. 1185.
1928:
1924:
1920:, p. 1116.
1916:
1905:
1901:, p. e370.
1897:
1893:
1885:
1881:
1877:, p. 2574.
1873:
1866:
1829:
1828:
1824:
1817:
1804:
1803:
1799:
1790:Wayback Machine
1780:
1776:
1740:
1739:
1735:
1698:
1697:
1693:
1662:
1661:
1657:
1621:
1620:
1616:
1587:(20): 2686–92.
1578:
1577:
1573:
1537:
1536:
1532:
1522:Wayback Machine
1513:
1509:
1473:
1472:
1468:
1464:, p. 1111.
1460:
1456:
1452:, p. e369.
1448:
1444:
1391:
1390:
1386:
1376:
1374:
1366:
1365:
1361:
1351:
1349:
1341:
1340:
1336:
1300:
1299:
1295:
1283:
1279:
1275:, p. 1194.
1271:
1267:
1263:, p. 1178.
1259:
1255:
1251:, p. 1118.
1247:
1243:
1203:
1168:
1164:
1160:
1148:
1135:
1134:
1130:
1123:
1110:
1109:
1105:
1097:
1084:
1083:
1079:
1075:, p. 3004.
1071:
1064:
1023:
1016:
1012:
976:
951:
939:benzodiazepines
928:
923:
883:quality of life
861:
833:hemodynamically
800:
799:
798:
797:
796:
789:
780:
779:
778:
768:
757:
751:
719:pentasaccharide
679:
671:catheterization
652:
643:ischemic stroke
631:
621:
606:
603:
577:
565:
536:
523:
511:slow heart rate
475:
467:pulmonary edema
433:Nitrates, like
431:
403:
395:unstable angina
338:
316:door-to-balloon
280:
221:
145:
125:unstable angina
70:
49:
42:coronary artery
12:
11:
5:
4076:
4074:
4066:
4065:
4060:
4055:
4050:
4045:
4035:
4034:
4028:
4027:
4025:
4024:
4014:
4004:
3994:
3984:
3973:
3970:
3969:
3967:
3966:
3961:
3960:
3959:
3949:
3944:
3939:
3934:
3929:
3924:
3919:
3914:
3909:
3904:
3898:
3896:
3895:Related topics
3892:
3891:
3889:
3888:
3887:
3886:
3876:
3871:
3866:
3861:
3856:
3851:
3846:
3844:Medical school
3840:
3838:
3830:
3829:
3826:
3825:
3823:
3822:
3821:
3820:
3810:
3805:
3800:
3798:Sleep medicine
3795:
3794:
3793:
3783:
3778:
3773:
3772:
3771:
3761:
3756:
3751:
3745:
3740:
3739:
3738:
3728:
3723:
3718:
3713:
3708:
3703:
3702:
3701:
3691:
3686:
3681:
3676:
3671:
3662:
3657:
3656:
3655:
3645:
3640:
3635:
3630:
3625:
3624:
3623:
3618:
3611:Anesthesiology
3608:
3603:
3597:
3595:
3591:
3590:
3588:
3587:
3586:
3585:
3580:
3575:
3570:
3565:
3560:
3550:
3549:
3548:
3543:
3541:Neuroradiology
3538:
3527:
3525:
3519:
3518:
3516:
3515:
3510:
3505:
3500:
3495:
3490:
3484:
3482:
3478:Obstetrics and
3474:
3473:
3471:
3470:
3465:
3460:
3455:
3450:
3445:
3440:
3435:
3430:
3429:
3428:
3418:
3413:
3408:
3403:
3393:
3391:
3383:
3382:
3380:
3379:
3374:
3373:
3372:
3362:
3360:Trauma surgery
3357:
3352:
3347:
3342:
3337:
3332:
3331:
3330:
3323:Otolaryngology
3320:
3315:
3310:
3305:
3300:
3299:
3298:
3293:
3283:
3278:
3273:
3268:
3262:
3260:
3251:
3249:subspecialties
3239:
3238:
3233:
3231:
3230:
3223:
3216:
3208:
3201:
3200:
3194:
3181:
3175:
3162:
3124:
3089:
3054:
3018:
3016:
3013:
3011:
3010:
2961:
2939:
2890:
2849:
2825:
2803:
2781:
2764:
2745:
2698:
2671:(9019): 7–12.
2654:
2613:
2572:
2536:
2515:(2): 370–377.
2495:
2446:
2395:
2391:Amsterdam 2014
2383:
2371:
2359:
2355:Amsterdam 2014
2347:
2335:
2323:
2319:Amsterdam 2014
2311:
2262:
2260:
2259:
2258:, p. 1186
2253:
2252:, p. 3013
2247:
2241:
2240:, p. 2589
2235:
2232:Amsterdam 2014
2229:
2228:, p. 1115
2215:
2208:
2190:
2178:
2174:Amsterdam 2014
2163:
2156:
2138:
2126:
2122:Amsterdam 2014
2114:
2057:
2055:
2054:
2019:
2018:, p. 2597
2013:
2007:
2006:, p. 1185
2001:
1987:
1975:
1954:(1): 168–177.
1934:
1922:
1903:
1891:
1887:Amsterdam 2014
1879:
1864:
1822:
1815:
1797:
1774:
1753:(7): 1339–45.
1733:
1691:
1655:
1614:
1571:
1530:
1507:
1486:(3): 671–719.
1466:
1454:
1442:
1384:
1359:
1334:
1293:
1277:
1265:
1253:
1241:
1239:
1238:
1201:
1158:
1156:, p. 1093
1146:
1128:
1121:
1103:
1095:
1077:
1062:
1046:Amsterdam 2014
1013:
1011:
1008:
975:
972:
967:cardiac arrest
950:
947:
927:
924:
922:
919:
908:motor vehicles
893:rehabilitation
860:
859:Rehabilitation
857:
844:stress testing
829:anticoagulated
817:bypass surgery
790:
783:
782:
781:
769:
762:
761:
760:
759:
758:
753:Main article:
750:
747:
721:antagonist of
678:
677:Anticoagulants
675:
651:
648:
629:
619:
605:
601:
598:
576:
573:
564:
561:
535:
532:
522:
521:Oxygen therapy
519:
487:cardiac output
474:
471:
430:
427:
402:
399:
337:
334:
289:nitroglycerine
279:
276:
220:
217:
144:
141:
87:in one of the
72:
71:
64:
61:
60:
57:
51:
50:
36:forming on an
31:
23:
22:
13:
10:
9:
6:
4:
3:
2:
4075:
4064:
4061:
4059:
4056:
4054:
4051:
4049:
4046:
4044:
4041:
4040:
4038:
4023:
4015:
4013:
4009:
4005:
4003:
3995:
3993:
3985:
3983:
3975:
3974:
3971:
3965:
3962:
3958:
3955:
3954:
3953:
3950:
3948:
3945:
3943:
3940:
3938:
3935:
3933:
3930:
3928:
3927:Public health
3925:
3923:
3920:
3918:
3915:
3913:
3910:
3908:
3907:Allied health
3905:
3903:
3900:
3899:
3897:
3893:
3885:
3882:
3881:
3880:
3877:
3875:
3872:
3870:
3867:
3865:
3862:
3860:
3857:
3855:
3852:
3850:
3847:
3845:
3842:
3841:
3839:
3837:
3831:
3819:
3816:
3815:
3814:
3811:
3809:
3806:
3804:
3801:
3799:
3796:
3792:
3789:
3788:
3787:
3784:
3782:
3779:
3777:
3774:
3770:
3767:
3766:
3765:
3762:
3760:
3757:
3755:
3752:
3749:
3746:
3744:
3741:
3737:
3734:
3733:
3732:
3729:
3727:
3724:
3722:
3719:
3717:
3716:Oral medicine
3714:
3712:
3711:Ophthalmology
3709:
3707:
3704:
3700:
3697:
3696:
3695:
3692:
3690:
3687:
3685:
3682:
3680:
3677:
3675:
3672:
3670:
3666:
3663:
3661:
3658:
3654:
3651:
3650:
3649:
3646:
3644:
3641:
3639:
3636:
3634:
3631:
3629:
3626:
3622:
3619:
3617:
3614:
3613:
3612:
3609:
3607:
3604:
3602:
3599:
3598:
3596:
3592:
3584:
3581:
3579:
3576:
3574:
3573:Cytopathology
3571:
3569:
3566:
3564:
3561:
3559:
3556:
3555:
3554:
3551:
3547:
3544:
3542:
3539:
3537:
3534:
3533:
3532:
3529:
3528:
3526:
3524:
3520:
3514:
3513:Urogynecology
3511:
3509:
3506:
3504:
3501:
3499:
3496:
3494:
3491:
3489:
3486:
3485:
3483:
3481:
3475:
3469:
3466:
3464:
3461:
3459:
3456:
3454:
3451:
3449:
3446:
3444:
3441:
3439:
3436:
3434:
3431:
3427:
3424:
3423:
3422:
3419:
3417:
3416:Endocrinology
3414:
3412:
3409:
3407:
3404:
3402:
3398:
3395:
3394:
3392:
3390:
3384:
3378:
3375:
3371:
3368:
3367:
3366:
3363:
3361:
3358:
3356:
3353:
3351:
3348:
3346:
3343:
3341:
3338:
3336:
3333:
3326:
3325:
3324:
3321:
3319:
3316:
3314:
3311:
3309:
3306:
3304:
3301:
3297:
3294:
3292:
3289:
3288:
3287:
3284:
3282:
3279:
3277:
3274:
3272:
3269:
3267:
3264:
3263:
3261:
3259:
3255:
3252:
3250:
3244:
3240:
3236:
3229:
3224:
3222:
3217:
3215:
3210:
3209:
3206:
3197:
3191:
3187:
3182:
3178:
3172:
3168:
3163:
3152:
3148:
3143:
3138:
3134:
3130:
3125:
3121:
3117:
3112:
3107:
3103:
3099:
3095:
3090:
3086:
3082:
3077:
3072:
3068:
3064:
3060:
3055:
3051:
3047:
3042:
3037:
3033:
3029:
3025:
3020:
3019:
3014:
3006:
3002:
2997:
2992:
2988:
2984:
2980:
2976:
2972:
2965:
2962:
2950:
2943:
2940:
2935:
2931:
2926:
2921:
2917:
2913:
2909:
2905:
2901:
2894:
2891:
2886:
2882:
2877:
2872:
2868:
2864:
2860:
2853:
2850:
2846:
2842:
2838:
2835:
2829:
2826:
2822:
2818:
2815:
2810:
2808:
2804:
2791:
2785:
2782:
2778:
2774:
2768:
2765:
2761:
2757:
2752:
2750:
2746:
2741:
2737:
2733:
2729:
2725:
2721:
2717:
2713:
2709:
2702:
2699:
2694:
2690:
2686:
2682:
2678:
2674:
2670:
2666:
2658:
2655:
2650:
2646:
2641:
2636:
2633:(12): 781–8.
2632:
2628:
2624:
2617:
2614:
2609:
2605:
2600:
2595:
2591:
2587:
2583:
2576:
2573:
2568:
2564:
2560:
2556:
2552:
2548:
2540:
2537:
2532:
2528:
2523:
2518:
2514:
2510:
2506:
2499:
2496:
2491:
2487:
2482:
2477:
2473:
2469:
2465:
2461:
2457:
2450:
2447:
2442:
2438:
2433:
2428:
2423:
2418:
2414:
2410:
2406:
2399:
2396:
2392:
2387:
2384:
2380:
2375:
2372:
2368:
2363:
2360:
2357:, p. 38.
2356:
2351:
2348:
2344:
2339:
2336:
2332:
2327:
2324:
2320:
2315:
2312:
2307:
2303:
2298:
2293:
2289:
2285:
2281:
2277:
2273:
2266:
2263:
2257:
2254:
2251:
2248:
2245:
2242:
2239:
2236:
2233:
2230:
2227:
2224:
2223:
2219:
2216:
2211:
2205:
2201:
2194:
2191:
2187:
2182:
2179:
2176:, p. 31.
2175:
2170:
2168:
2164:
2159:
2153:
2149:
2142:
2139:
2135:
2130:
2127:
2124:, p. 30.
2123:
2118:
2115:
2110:
2106:
2101:
2096:
2092:
2088:
2084:
2080:
2076:
2072:
2068:
2061:
2058:
2051:
2047:
2042:
2037:
2033:
2029:
2025:
2020:
2017:
2014:
2011:
2008:
2005:
2002:
1999:
1996:
1995:
1991:
1988:
1984:
1979:
1976:
1971:
1967:
1962:
1957:
1953:
1949:
1945:
1938:
1935:
1931:
1926:
1923:
1919:
1914:
1912:
1910:
1908:
1904:
1900:
1895:
1892:
1889:, p. 14.
1888:
1883:
1880:
1876:
1871:
1869:
1865:
1859:
1855:
1850:
1845:
1841:
1837:
1833:
1826:
1823:
1818:
1812:
1808:
1801:
1798:
1794:
1793:STEMI Systems
1791:
1787:
1784:
1778:
1775:
1770:
1766:
1761:
1756:
1752:
1748:
1744:
1737:
1734:
1728:
1724:
1719:
1714:
1710:
1706:
1702:
1695:
1692:
1687:
1683:
1679:
1675:
1671:
1667:
1659:
1656:
1651:
1647:
1642:
1637:
1633:
1629:
1625:
1618:
1615:
1610:
1606:
1602:
1598:
1594:
1590:
1586:
1582:
1575:
1572:
1567:
1563:
1558:
1553:
1549:
1545:
1541:
1534:
1531:
1527:
1523:
1519:
1516:
1511:
1508:
1503:
1499:
1494:
1489:
1485:
1481:
1477:
1470:
1467:
1463:
1458:
1455:
1451:
1446:
1443:
1438:
1434:
1429:
1424:
1420:
1416:
1412:
1408:
1404:
1400:
1396:
1388:
1385:
1373:
1369:
1363:
1360:
1348:
1344:
1338:
1335:
1330:
1326:
1321:
1316:
1312:
1308:
1304:
1297:
1294:
1291:
1290:
1286:
1281:
1278:
1274:
1269:
1266:
1262:
1257:
1254:
1250:
1245:
1242:
1235:
1231:
1227:
1223:
1219:
1215:
1211:
1207:
1202:
1198:
1194:
1189:
1184:
1180:
1176:
1172:
1167:
1166:
1162:
1159:
1155:
1149:
1143:
1139:
1132:
1129:
1124:
1118:
1114:
1107:
1104:
1098:
1092:
1088:
1081:
1078:
1074:
1069:
1067:
1063:
1059:
1055:
1051:
1047:
1043:
1039:
1035:
1031:
1027:
1021:
1019:
1015:
1009:
1007:
1005:
1001:
997:
993:
989:
985:
981:
980:first aid kit
973:
971:
968:
964:
960:
956:
948:
946:
944:
940:
936:
935:beta blockers
932:
925:
921:Special cases
920:
918:
916:
911:
909:
906:
902:
898:
894:
890:
886:
884:
880:
876:
874:
870:
866:
858:
856:
852:
848:
845:
842:
838:
834:
830:
826:
820:
818:
814:
810:
806:
794:
787:
776:
772:
766:
756:
748:
746:
744:
740:
739:intravenously
736:
732:
728:
724:
720:
716:
712:
708:
704:
700:
696:
692:
688:
684:
676:
674:
672:
668:
664:
660:
656:
649:
647:
644:
640:
635:
627:
623:
615:
611:
599:
597:
595:
591:
586:
585:rate of death
582:
574:
572:
570:
562:
560:
558:
554:
549:
545:
541:
533:
531:
529:
520:
518:
516:
512:
508:
504:
500:
496:
492:
488:
484:
483:beta blockers
480:
473:Beta blockers
472:
470:
468:
464:
460:
456:
452:
448:
444:
440:
436:
435:nitroglycerin
428:
426:
424:
420:
419:beta blockers
416:
412:
408:
400:
398:
396:
393:(NSTEMI) and
392:
388:
383:
379:
375:
371:
367:
364:setting; the
363:
355:
351:
347:
342:
335:
333:
330:
325:
321:
317:
313:
309:
304:
302:
298:
294:
290:
286:
277:
275:
271:
267:
263:
261:
257:
253:
252:nitroglycerin
249:
244:
242:
238:
230:
225:
218:
216:
213:
211:
207:
203:
199:
195:
189:
187:
183:
179:
175:
169:
167:
162:
158:
154:
149:
142:
140:
138:
137:complications
134:
130:
126:
122:
118:
114:
110:
106:
102:
98:
94:
90:
86:
82:
78:
68:
58:
56:
52:
47:
43:
39:
35:
29:
24:
19:
16:
3932:Rural health
3917:Nanomedicine
3468:Rheumatology
3399: /
3318:Hand surgery
3303:Neurosurgery
3185:
3166:
3156:27 September
3154:. Retrieved
3132:
3101:
3097:
3066:
3062:
3031:
3027:
2978:
2974:
2964:
2953:. Retrieved
2942:
2907:
2903:
2893:
2866:
2862:
2852:
2828:
2794:. Retrieved
2784:
2767:
2715:
2711:
2701:
2668:
2664:
2657:
2630:
2627:N Engl J Med
2626:
2616:
2592:(8): 901–4.
2589:
2585:
2575:
2550:
2546:
2539:
2512:
2508:
2498:
2463:
2459:
2449:
2412:
2408:
2398:
2386:
2374:
2367:Antman 2012b
2362:
2350:
2338:
2326:
2314:
2279:
2275:
2265:
2234:, p. 39
2226:Antman 2012b
2218:
2199:
2193:
2181:
2147:
2141:
2129:
2117:
2074:
2070:
2060:
2031:
2027:
1998:Antman 2012b
1990:
1978:
1951:
1947:
1937:
1925:
1918:Antman 2012b
1894:
1882:
1839:
1835:
1825:
1806:
1800:
1792:
1777:
1750:
1746:
1736:
1711:(8): 770–7.
1708:
1705:Eur. Heart J
1704:
1694:
1672:(2): 53–61.
1669:
1665:
1658:
1634:(4): 661–7.
1631:
1627:
1617:
1584:
1580:
1574:
1547:
1543:
1533:
1510:
1483:
1479:
1469:
1462:Antman 2012b
1457:
1445:
1405:(1): 25–28.
1402:
1398:
1387:
1375:. Retrieved
1371:
1362:
1352:30 September
1350:. Retrieved
1346:
1337:
1310:
1306:
1296:
1287:
1280:
1268:
1256:
1249:Antman 2012b
1244:
1212:(9): 493–5.
1209:
1205:
1178:
1174:
1161:
1154:Antman 2012a
1137:
1131:
1112:
1106:
1086:
1080:
977:
952:
929:
912:
887:
877:
862:
853:
849:
841:non-invasive
821:
801:
735:parenterally
715:fondaparinux
680:
663:eptifibatide
653:
639:fibrinolysis
624:, a type of
607:
594:loading dose
578:
566:
537:
524:
503:Killip class
477:By reducing
476:
439:sublingually
432:
409:that causes
404:
359:
305:
281:
272:
268:
264:
245:
234:
214:
190:
170:
150:
146:
81:heart muscle
76:
75:
46:heart muscle
15:
4002:Wikiproject
3791:Venereology
3736:Neonatology
3633:Dermatology
3488:Gynaecology
3480:gynaecology
3463:Pulmonology
3281:Eye surgery
3243:Specialties
3133:Circulation
3098:Circulation
2863:Circulation
2586:Eur Heart J
2460:Circulation
2343:O'Gara 2013
2256:Cannon 2012
2244:O'Gara 2013
2186:O'Gara 2013
2028:Circulation
2010:O'Gara 2013
2004:Cannon 2012
1948:Circulation
1930:Cannon 2012
1899:O'Gara 2013
1628:Am. Heart J
1550:(1): 71–7.
1450:O'Gara 2013
1377:22 December
1307:Circulation
1273:Cannon 2012
1261:Cannon 2012
1152:. Cited in
1042:O'Gara 2013
749:Reperfusion
727:bivalirudin
590:clopidogrel
548:hemodynamic
491:arrhythmias
479:sympathetic
463:Intravenous
447:hypotension
362:prehospital
308:primary PCI
4037:Categories
3764:Psychiatry
3750:(PM&R)
3743:Phlebology
3731:Pediatrics
3558:Anatomical
3523:Diagnostic
3503:Obstetrics
3453:Nephrology
3438:Hematology
3433:Geriatrics
3426:Hepatology
3411:Cardiology
3401:Immunology
2955:2008-06-12
1206:Med J Aust
1026:guidelines
1010:References
974:Air travel
959:evacuation
707:enoxaparin
683:ventricles
610:ticagrelor
604:inhibitors
534:Analgesics
457:(used for
451:sildenafil
350:ST segment
161:cell death
119:elevation
117:ST segment
93:chest pain
85:blood clot
59:cardiology
34:blood clot
3952:Physician
3836:education
3694:Neurology
3689:Narcology
3553:Pathology
3531:Radiology
3406:Angiology
3370:Andrology
2796:April 22,
2481:1765/5495
2379:Steg 2012
2331:Steg 2012
2282:: g6269.
2250:Hamm 2011
2238:Steg 2012
2134:Steg 2012
2091:1469-493X
2016:Steg 2012
1983:Steg 2012
1875:Steg 2012
1419:2434-0790
1101:, p. 1092
1073:Hamm 2011
1058:Hamm 2011
1054:Steg 2012
723:factor Xa
667:tirofiban
659:abciximab
614:prasugrel
453:or other
443:monitored
198:platelets
55:Specialty
3982:Category
3458:Oncology
3389:medicine
3387:Internal
3235:Medicine
3151:25249586
3120:23247304
3085:21873419
3050:22922416
3005:11090520
2934:16450811
2885:18347214
2837:Archived
2817:Archived
2740:24212782
2693:21284044
2608:16543251
2441:22361039
2415:(9): 9.
2306:25954988
2109:27991651
2050:17562966
1858:22922414
1786:Archived
1769:16580518
1727:15684279
1686:18340140
1650:16996830
1609:20363018
1601:10819952
1566:12103258
1518:Archived
1502:15358045
1437:35083385
1329:11551867
1226:21034380
1197:18926324
699:catheter
622:receptor
581:platelet
544:morphine
429:Nitrates
415:nitrates
344:Typical
293:morphine
4022:Outline
3992:Commons
3937:Therapy
3834:Medical
3397:Allergy
3365:Urology
3258:Surgery
2996:1119071
2925:6654328
2758:. U.S.
2732:9078197
2685:8691967
2649:1900101
2567:7905143
2531:7829790
2490:7882472
2432:3359186
2297:4208629
2100:6463792
1970:9884398
1862:p. 2553
1428:8710642
988:aspirin
986:spray,
963:MEDEVAC
931:Cocaine
926:Cocaine
905:driving
575:Aspirin
540:opioids
501:(e.g.,
297:aspirin
256:aspirin
111:on the
4012:Portal
3879:MD–PhD
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1093:
1000:oxygen
998:, and
992:opioid
897:stress
725:) and
687:stroke
553:angina
423:oxygen
348:of an
295:, and
285:oxygen
3594:Other
2736:S2CID
2689:S2CID
2222:See:
1994:See:
1605:S2CID
1234:72135
1230:S2CID
1165:See:
990:, or
793:stent
354:leads
306:With
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40:in a
3190:ISBN
3171:ISBN
3158:2014
3147:PMID
3116:PMID
3081:PMID
3046:PMID
3001:PMID
2930:PMID
2881:PMID
2798:2007
2728:PMID
2681:PMID
2645:PMID
2604:PMID
2563:PMID
2527:PMID
2486:PMID
2437:PMID
2302:PMID
2204:ISBN
2152:ISBN
2105:PMID
2087:ISSN
2075:2016
2046:PMID
1966:PMID
1854:PMID
1811:ISBN
1765:PMID
1723:PMID
1682:PMID
1646:PMID
1597:PMID
1581:JAMA
1562:PMID
1498:PMID
1433:PMID
1415:ISSN
1379:2014
1354:2014
1325:PMID
1222:PMID
1193:PMID
1142:ISBN
1117:ISBN
1091:ISBN
1036:and
901:mood
899:and
827:and
665:and
612:and
421:and
155:(or
135:and
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3328:ENT
3246:and
3137:doi
3106:doi
3102:127
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2991:PMC
2983:doi
2979:321
2920:PMC
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2871:doi
2867:117
2843:".
2777:BBC
2720:doi
2716:349
2673:doi
2669:348
2635:doi
2631:324
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2555:doi
2551:343
2517:doi
2476:hdl
2468:doi
2427:PMC
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2292:PMC
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2280:349
2276:BMJ
2095:PMC
2079:doi
2036:doi
2032:115
1956:doi
1844:doi
1755:doi
1713:doi
1674:doi
1636:doi
1632:152
1589:doi
1585:283
1552:doi
1488:doi
1423:PMC
1407:doi
1315:doi
1311:104
1289:BBC
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1210:193
1183:doi
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915:sex
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