The most common causes of<unk><unk>  remain MI. The American College of Cardiology and American Heart Association, in collaboration with the Canadian Cardiovascular Society, have issued an update of the 2004 guideline for the management of patients with ST-segment elevation myocardial infarction. The American Academy of Family Physicians endorses and accepts this guideline as its policy. Early recognition and prompt initiation of reperfusion therapy remains the cornerstone of management of ST-segment elevation myocardial infarction. Aspirin should be given to symptomatic patients. Beta blockers should be used cautiously in the acute setting because they may increase the risk of<unk><unk>  and death. The combination of clopidogrel and aspirin is indicated in patients who have had ST-segment elevation myocardial infarction. A stepped care approach to analgesia for musculoskeletal pain in patients with coronary heart disease is provided. Cyclooxygenase inhibitors and nonsteroidal anti-inflammatory drugs increase mortality risk and should be avoided.<unk><unk>  is important to reduce the burden of heart disease. Secondary<unk>  interventions are critically important to prevent recurrent events in patients who survive. Available data indicate that the development of<unk>  after hospital admission with acute MI is as common as<unk><unk>  on presentation. Because of the > 50% mortality associated with both of these conditions, the most favorable means of making an impact on<unk>  mortality is to prevent its development. Therefore, effective therapy for<unk>  must include a<unk>  strategy. In the GUSTO study, 70% of patients who developed<unk><unk>  after admission were Killip class I on admission, and of the remaining patients most were in Killip class II with only mild heart failure. For this reason, other clinical clues must be used to recognize patients at high risk for developing<unk> . The development of tachycardia or evidence of peripheral vasoconstriction are early clinical signs ofthe "preshock" state. Data from the Secondary<unk>  Reinfarction Israel Nifedipine Trial (SPRINT) study") suggest that the presence of diabetes, history of angina, peripheral vascular or cerebrovascular disease, prior MI, and female gender are all risks for development of<unk>  in Killip class I patients with acute infarction. These investigators estimated a 35% probability of developing<unk>  if all six of these factors were present on admission. In addition to these clinical factors obtained from the history and physical examination, diagnostic studies such as early two-dimensional echocardiography may be helpful in evaluating selected patients. In a consecutive series of over 80 patients, Gibson etnl. stratified patients with acute MI into two groups: those with asynergy in the infarct zone only and those with asynergy in the infarct zone plus a remote zone. They found that the latter group had a significantly higher incidence of<unk><unk>  (34 vs. 8%, p = 0.01), as well as higher rates of death, reinfarction, and Killip class progression than patients with asynergy in the infarct zone only. It is likely that all of the above information is helpful in identifying patients with triple-vessel coronary artery disease in an otherwise low-risk clinical group (i.e., patients without heart failure on admission).
Cardiogenic shock primary prevention
Cardiogenic shock secondary prevention
Fat embolism syndrome primary prevention
ST elevation myocardial infarction pre-hospital care
ST elevation myocardial infarction complications
ST elevation myocardial infarction oxygen therapy
Sudden cardiac death urgent treatment
Cardiogenic shock diagnostic criteria