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Patients with cardiac chest pain should call emergency services

BMJ 2007; 335 doi: (Published 27 September 2007) Cite this as: BMJ 2007;335:669
  1. Will T Roberts, research fellow,
  2. Adam D Timmis, professor of clinical cardiology
  1. Department of Cardiology, London Chest Hospital, London E2 9JX
  1. Correspondence to: A Timmis adamtimmis{at}

    Key points

    • In acute myocardial infarction the most important means of saving life is to get the patient to a defibrillator and to start reperfusion therapy as soon as possible after the onset of symptoms

    • The time it takes patients with chest pain to seek help accounts for up to 75% of the total delay before treatment

    • Ambulance transport is the most effective means of accessing medical help, yet up to half of all patients with myocardial infarction do not use the emergency services

    • Healthcare professionals who deal with at-risk groups should educate them about how to recognise symptoms and the need to act quickly in the event of cardiac chest pain by calling for help from emergency services, rather than consulting general practitioners or medical helplines

    The clinical problem

    In acute myocardial infarction, the risk of ventricular fibrillation (and the capacity for external defibrillation or reperfusion therapy to reduce mortality) is highest in the first 12 hours after onset of symptoms. In hospital, reperfusion therapy is now given rapidly in most cases, but the time it takes the patient with chest pain to seek medical help has resisted change.1 This delay accounts for as much as 75% of the total delay to treatment,2 and in patients outside of hospital, ventricular fibrillation …

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