About half the patients who suffer acute myocardial infarction die within a month, many within two hours of the onset of symptoms. Most early deaths (and some late deaths) are caused by arrhythmias, especially ventricular fibrillation (VF). Other late deaths are related to the extent of myocardial damage or to a further infarction. The early management of suspected myocardial infarction is therefore directed towards the relief of pain, to preventing and treating serious arrhythmias and to limiting myocardial damage.1 To what extent can treatment to achieve these aims be started outside hospital?
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