Part 1: Acute chest pain

Cardiovascular disease is Australia’s largest health problem. It kills more people than any other disease and generates enormous costs for the Australian health care system. The major types of cardiovascular disease are ischaemic heart disease (IHD), cerebrovascular accident (CVA), peripheral vascular disease (PVD) and congestive heart failure (CHF). Rheumatic fever and rheumatic heart disease are also very important and are encountered frequently in the Aboriginal and Torres Strait Islander peoples. IHD results in a heavy physical and emotional burden upon individuals and families. In 1996 it accounted for 13 % of the total disease burden in the country, 19 % of premature mortality and 5% of years of equivalent ‘healthy ’ life lost through disease, impairment or disability.1 In 1998–99 there were 437,717 hospitalisations in Australia where cardiovascular disease was the principal diagnosis (7 % of all hospitalisations). Of these, IHD accounted for 158,131 of them. Acute myocardial infarction then accounted for 33,908 of the 158,131 figure. Further sobering information is that, during the same time, there was a total of 27,825 deaths from IHD, both in and out of hospital.1 Trends in the rate of fatal and non-fatal myocardial infarction among males and females aged 35