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Nitroglycerin is the first-line therapy for angina. Other considerations are smoking cessation and cardiac rehabilitation with a physical exercise program guided by exercise testing if needed. Additional evaluation with stress testing and imaging is guided by patient clinical status.Complications after acute myocardial infarction (MI) can be serious and potentially life-threatening. Coronary reperfusion therapy and revascularization can reduce the risk of these complications, but they still occur. Arrhythmias and conduction abnormalities are among the most common complications, and occur most often in hemodynamically unstable patients. Patients with ventricular arrhythmias should be treated with beta blockers and sometimes amiodarone, along with cardioversion and defibrillation if unresponsive to medical therapy. [https://www.selleckchem.com/Proteasome.html Proteasome structure] Patients with bradyarrhythmias initially can be treated with atropine but may need pacemaker therapy. Atrial fibrillation (AF) is managed with standard pharmacotherapy; cardioversion is indicated if the patient is hemodynamically unstable and has persistent AF. Anticoagulation should be started based on the CHA2DS2-VASc score. Cardiogenic shock requires prompt diagnosis with echocardiography and urgent revascularization. Mechanical complications include ventricular aneurysm (managed medically with anticoagulation or surgically if the aneurysm is large), papillary muscle rupture (managed with mitral valve replacement), and ventricular septal rupture (which requires surgical repair). Conditions that mimic acute coronary syndrome (ACS) include cocaine-induced chest pain, pericarditis, myocarditis, coronary artery dissection, and Takotsubo cardiomyopathy. These conditions, each with its own specific diagnostic criteria, should be considered when the clinical picture and test results are not fully consistent with ACS. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.Aspirin is recommended for all patients with a suspected acute coronary syndrome (ACS) unless contraindicated. Addition of a second antiplatelet (ie, dual antiplatelet therapy) (eg, clopidogrel, ticagrelor, or prasugrel) also is recommended for most patients. Parenteral anticoagulation is recommended with unfractionated heparin, low-molecular-weight heparin, bivalirudin, and fondaparinux. Proton pump inhibitors are recommended to prevent bleeding due to antiplatelet and anticoagulation use in patients at higher than average risk of gastrointestinal bleeding. Other medical therapies should include statins, angiotensin-converting enzyme inhibitors, beta blockers, nitroglycerin and morphine (to relieve chest pain), and oxygen. For patients with an ST-segment elevation myocardial infarction, percutaneous coronary intervention (PCI) with stent placement should be performed as soon as possible. However, fibrinolytic therapy should be used first if PCI will be delayed for more than 120 minutes. For non-ST-segment elevation ACS, PCI is recommend; fibrinolytic therapy typically is not recommended. If patients require coronary artery bypass graft to reestablish coronary artery flow, it ideally is delayed 3 to 7 days after admission unless the patient has cardiogenic shock, life-threatening arrhythmias, three-vessel disease (with 70% occlusion each), greater than 50% left main coronary artery occlusion, unsuccessful or complicated PCI, or mechanical complications (eg, valve rupture). Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.Acute coronary syndrome (ACS) is an acute myocardial infarction (MI) or ischemia, usually from acutely disrupted coronary artery blood flow. Patients commonly present to the emergency department (ED) with chest pain or pressure but sometimes have atypical symptoms. Evaluation begins with an electrocardiogram (ECG) obtained within 10 minutes of presentation. If ST-segment elevation is present, ST-segment elevation MI (STEMI) is diagnosed. If STEMI is not present, troponin levels should be measured using one of several recommended protocols. Troponin levels greater than 99th percentile of the upper reference limit are consistent with ACS. If the ECG finding is normal and results of two troponin tests are negative, risk stratification should be calculated using Thrombosis in Myocardial Infarction (TIMI) or HEART (History, ECG, Age, Risk factors, initial Troponin) score. Based on the score, further evaluation to exclude coronary artery disease (CAD) is completed during hospitalization or after discharge, using exercise treadmill testing, stress echocardiography, myocardial perfusion scintigraphy, or coronary computed tomography angiography. Although ACS is less likely in outpatients, CAD must still be considered. Many patients with ACS are misdiagnosed. Between 2% and 5% of patients are inappropriately discharged from the ED. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.The authors and journal apologise for an error in the above paper, which appeared in volume 199 part 2, pages 275–286. The error relates to Fig. 10, given on page 283. Society for Endocrinology 2019Bisphophonates (BPs) are a group of drugs used in treating bone diseases, which may lead to the development of the osteonecrosis of the jaw (ONJ). The negative impact of BPs on angiogenesis is among the causes of ONJ. The specific mechanisms of complications are unknown. What is taken into consideration is the trauma background, which, in combination with the implemented BP treatment, can induce bone necrosis. One of the possible consequences of necrotic change progression is the development of an oronasal fistula. Treatment generally requires a surgical intervention.The paper describes the course of treatment of an oronasal fistula in a patient with BP osteitis, currently using an upper denture. The fistula arose a year after the removal of a protruding sequestrum in the region of the hard palate. An attempt was made to treat the fistula by the mobilization of soft tissues from the palate and the bilayered closure of the fistula with the use of a pedicled connective tissue graft on the greater palatine artery, along with a Tinti-Parma-Benfenati (TPB) flap.