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Table of contents: Full Text (ESC Clinical Practice Guidelines)
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Introduction
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The definition of acute myocardial infarction, The pathogenesis of ST-segment elevation acute myocardial infarction,The natural history of STEMI
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First medical contact and emergency care flow
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Initial diagnosis and early risk stratification, Relief of pain, breathlessness, and anxiety, Cardiac arrest
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Pre-hospital or early in-hospital care
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Restoring coronary flow and myocardial tissue reperfusion:
Percutaneous coronary interventions, Fibrinolytic treatment, Antithrombotic therapy without reperfusion therapy, Prevention and treatment of microvascular obstruction and reperfusion injury, Coronary bypass surgery
Pump failure and shock:
Clinical features, Mild heart failure (Killip class II), Severe heart failure and shock (Killip class III and IV)
Mechanical complications:
Cardiac rupture and mitral regurgitation, Cardiac rupture, Mitral regurgitation
Arrhythmias and conduction disturbances in the acute
phase:
Ventricular arrhythmias, Supraventricular arrhythmias, Sinus bradycardia and heart block
Routine prophylactic therapies in the acute phase:
Antithrombotic agents: aspirin, clopidogrel, and antithrombins, Antiarrhythmic drugs, b-Blockers, Nitrates, Calcium antagonists, Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, Magnesium, Glucose–insulin–potassium
Management of specific types of infarction:
Right ventricular infarction, Myocardial infarction in diabetic patients, Patients with renal dysfunction
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Management of the later in-hospital course
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Ambulation
Management of specific in-hospital complications:
Deep vein thrombosis and pulmonary embolism, Intraventricular thrombus and systemic emboli, Pericarditis, Late ventricular arrhythmias, Post-infarction angina and ischaemia
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Risk assessment
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Indications and timing, Assessment of myocardial viability, Evaluation of risk of arrhythmia for prevention of
sudden death |
Rehabilitation and pre-discharge advice
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Psychological and socio-economic aspects, Lifestyle advice, Physical activity |
Secondary prevention
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Smoking cessation, Diet, dietary supplements, and weight control, Physical activity, Antiplatelet and anticoagulant treatment, b-Blockers, Calcium antagonists, Nitrates, Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, Aldosterone blockade, Blood pressure control, Management of diabetes,
Interventions on lipid profile, Influenza vaccination, Cardiac resynchronization therapy, Prophylactic implantation of an implantable cardioverter–defibrillator |
Logistics of care
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Pre-hospital care
Patient delay, Emergency medical system, Public education in cardiopulmonary resuscitation, The ambulance service, Networks, General practitioners, Admission procedures
The Intensive Cardiac Care Unit:
Non-invasive monitoring, Invasive monitoring
The post-discharge period
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Gaps in evidence
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