All junior doctors and in particular trainee cardiologists will at some point in their training be involved in managing acute coronary syndromes and other cardiac emergencies. This handbook sets out the recognized clinical steps to take and backs them up with an analysis of the evidence supporting these decisions. "Evidence-Based Coronary Care" will provide junior doctors with the answers they seek when dealing with difficult clinical situations. Evidence-Based medicine is still very topical, and this book will adopt a similar style to James: Evidence-Based Obstetrics in setting out the clinical management plan on the verso page and the evidence supporting that plan on the recto page.
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1.1 Immediate management of chest pain compatible with MI Immediate treatment. Definitive treatment Contra-indications to thrombolytic therapy Management of the patient ineligible for thrombolytic therapy Who should receive tPA? Assessing reperfusion after thrombolysis Problems following thrombolytic therapy Patients with diabetes and acute MI Treatment of 'difficult' MIs SECTION II: SUBSEQUENT CCU MANAGEMENT OF MI Early CCU management Early risk stratification Routine management from day 1 Complications of MI SECTION III: RISK STRATIFICATION POST MI Clinical risk stratification Using exercise and other stress testing Autonomic markers of post MI risk Out-patient follow up Pre-discharge checklist SECTION IV: EARLY REHABILITATION, SECONDARY PREVENTION AND OUT-PATIENT FOLLOW-UP OF MI Cardiac rehabilitation and secondary prevention Fitness to drive Checklist for outpatient review post MI SECTION V: MANAGEMENT OF OTHER ACUTE CORONARY SYNDROMES Unstable angina Non-Q wave MI Pre-discharge checklist SECTION VI: DRUGS IN COMMON USE IN MI AND UNSTABLE ANGINA Aspirin and other anti-platelet agents Beta-blockers Calcium antagonists ACE inhibitors Lipid lowering agents Nitrates Inotropes Heparin, warfarin and antithrombins Amiodarone SECTION VII: OTHER EMERGENCIES IN CCU Tachycardias Bradycardias Pacemakers Automatic cardioverter-defibrillators
