Clinical presentation

• Pain. This is the initial response to myocardial ischaemia. Typically the pain is central and gripping in nature. Commonly it radiates to the left arm, though pain can be reported anywhere in the chest, arms, neck, jaw and teeth (Albarran 2002). However, up to 25% of AMIs are 'silent' (pain free), more commonly in people aged over 65 and diabetics (Hand 2001).

• Nausea and vomiting.

Chest pain or any other suspected ACS should be treated as a medical emergency. Up to 30% of patients with acute chest pain are suffering from ACS (Domanovits et al. 2002). At presentation the goals are:

• diagnosis, including investigations;

• specific treatment.

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