1. Stable angina - 3% risk per year of progression to MI/death
2. Treatment for angina:
- Decrease O2 demand: b-blockers, ca-channel blockers
- Increase O2 supply: nitrates
- Anticoagulate: aspirin, plavix in people s/p stent or who can't take aspirin
- Statin
- ACE/ARB in diabetics or people with HF
3. STEMI vs NSTEMI
STEMI = transmural ischemia or infarction
NSTEMI = subendomyocardial ischemia
4. Chest pain in the ER
- Around 15% of people with chest pain in the ER are having an MI
- New 1mm ST elevation: 80% prevalence of MI
- New ST depression/inversion: 20%
- No new changes in patient with known CAD: 4%
- No new changes in a patient without known CAD: 2%
5. Utility of physical exam findings for diagnosing MI {JAMA}

6. Cardiac enzymes
- Troponin and CKMB are both very sensitive and specific for MI. CKMB is not useful after 24 hours.
- Renal insufficiency can cause falsely elevated troponin, but even in people with high baseline troponin it should still rise and fall in acute MI
7. GERD vs MI
- Most helpful history: pain that is recurrent (>1/month), persists for several hours, awakens someone at night, provoked by recumbency, assoc with heartburn/regurg is much more likely to be GERD
- Symptoms that are NOT helpful for distinguishing the two (surprisingly): radiation to L arm, exacerbation with exercise, relief with nitroglycerin.
- Repeat: relief with nitroglycerin is useless in differentiating angina from GERD or other causes of chest pain
8. When to scope someone with GERD:
- Symptoms of complicated disease (dysphagia, extra-esophageal symptoms, bleeding, weight loss, chest pain of unclear etiology)
- Risk for Barett's (long standing reflux symptoms)
- Patients require long-term treatment
- Poor response to treatment
9. When to get pH monitoring:
- GERD sx + normal endoscopy
- Monitoring therapy in refractory cases
10. Surgery: 
- Limited role
- ONe study found a higher mortality of those treated with surgery at 11 years than those treated medically, #needed to harm = 8.3