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Reference
1. Chew DP, Aroney CN, Aylward PE, et al. 2011 addendum to the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand
guidelines for the management of acute coronary syndromes (ACS) 2006. Heart Lung Circ 2011; 20(8):487502.
References
1. National Heart Foundation of Australia. Heart Attack Facts. Available from: http://www.heartattackfacts.org.au. Accessed 19 June 2012.
2. National Heart Foundation of Australia. The shifting burden of cardiovascular disease, report prepared by Access Economics. Melbourne: National Heart Foundation of Australia, 2005.
Reference
1. Chew DP, Allan RM, Aroney CN, et al. National data elements for the clinical management of acute coronary syndromes. Med J Aust 2005; 182 (9 Suppl):S1S14.
The pain may spread to other parts of the upper body, including:
back, neck, jaw, arm(s), shoulder(s) or epigastric pain.
Reference
1. Chew DP, Aroney CN, Aylward PE, et al. 2011 addendum to the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand guidelines for the
management of acute coronary syndromes (ACS) 2006. Heart Lung Circ 2011; 20(8):487502.
For example: iCCnet CHSA network links > 70 hospitals, health centres and general
practitioner [GP] surgeries across SA, aligned to the Health Reform Agenda principles.
< 1 hour
Aborted heart attack or only little heart muscle damage
12 hours
Minor heart muscle damage only
24 hours
Some heart muscle damage with moderate heart muscle salvage
46 hours
Significant heart muscle damage with only minor heart muscle salvage
612 hours
No heart muscle salvage (permanent loss) with potential infarct
healing benefit
> 12 hours
Reperfusion is not routinely recommended if the patient is
asymptomatic and haemodynamically stable
Reference
1. Acute Coronary Syndrome Guidelines Working Group. Guidelines for the management of acute coronary syndromes 2006. Med J Aust 2006; 184(8 Suppl):S929.
Reference
1. Chew DP, Aroney CN, Aylward PE, et al. 2011 addendum to the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand guidelines for
the management of acute coronary syndromes (ACS) 2006. Heart Lung Circ 2011; 20(8):487502.
2012 National Heart Foundation of Australia
Bleeding risk
The following risk factors should be considered when assessing bleeding risk and
choosing antithrombotic therapies in patients with ACS (Grade B):
age > 75 years
female
history of bleeding
history of stroke or transient ischaemic attack (TIA)
creatinine clearance rate < 60 mL/min
diabetes
heart failure
tachycardia
blood pressure < 120 mmHg or 180 mmHg
peripheral vascular disease (PVD)
anaemia
concomitant use of GP IIb/IIIa inhibitor
enoxaparin 48 hours prior
switching between unfractionated heparin and enoxaparin
procedural factors (femoral access, prolonged, intra-aortic balloon pump, right heart
catheterisation).
2012 National Heart Foundation of Australia
Fibrinolysis
Fibrinolysis is the administration of a pharmacologic agent to break down blood clots
in the coronary vessels to restore blood flow to the heart muscle. 1
Consider early routine revascularisation of patients receiving fibrinolysis, regardless
of success of pharmacologic reperfusion (Grade A).
Absolute contraindications
Active bleeding or bleeding diathesis (excluding menses).
Significant closed head or facial trauma within 3 months.
Suspected aortic dissection.
Any prior intracranial haemorrhage.
Ischaemic stroke within 3 months.
Known structural cerebral vascular lesion.
Known malignant intracranial neoplasm.
Reference
1. Dugdale DC , Chen Y-B, Zieve D, et al. Fibrinolysis primary or secondary fibrinolysis. Available from: http://www.nlm.nih.gov/medlineplus/ency/article/000577.htm.
Accessed 7 August 2011.
Pregnancy.
Appropriate period of
observation. Consider if
stress test (e.g. exercise
ECG) needed?
YES NO
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