2. Angina, Nstmi, Stemi

Question 1

Acute coronary syndrome

ACS

What is it

Answer 1

Acute coronary syndrome is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart

Including

Unstable angina

Non- ST- elevated myocardial infarction

ST- elevated myocardial infraction

Question 2

What is

Unstable angina

Answer 2

Unstable angina is a condition in which your heart doesn’t get enough blood flow and oxygen. It may lead to a heart attack

Question 3

Unstable angina

SYMPTOMS

Answer 3

Chest pain that you may also feel in the shoulder, arm, jaw, neck, back, or other area.

Discomfort that feels like tightness, squeezing, crushing, burning, choking, or aching.

Discomfort that occurs at rest and does not easily go away when you take medicine.

Shortness of breath.

Sweating

Question 4

ACS

Secondary Prevention
(Long term Managment)

ACS AB

Answer 4

A aspirin

S statin

C clopidogrel (4weeks in stemi; 1 yr in NSTEMI /UA)

A ace/arb

B bb

Question 5

ACS

Secondary Prevention
(Long term Managment)

If bb not tolerated

How to treat

ARC

Answer 5

rivaroxaban 5mg (low dose)

Aspirin 75

Clopidogrel 150 for 1 yr

Question 6

Length of treatment

Clopidogrel

In

STEMI

Answer 6

4 weeks

Question 7

Length of treatment with clopidogrel in

UA/NSTEMI

Answer 7

1 yr

Question 8

Initial treatment of ACS

6

Answer 8

1. O2 at 97% or more (COPD lower is normal)
2. GTN SL/IV or IV ISOSORBIDE
3. Aspirin 300mg + Clopidogrel 300mg (+ note)
4. IV morphine/ dimorphine
   +
   IV metroclopramide
5. PCI preformed within 120 mints of MI
   Or
   Thromolytic given: alteplase (within 4.5hrs)
   Or
   Streptokinase (within 12 hrs)
6. LMWH injected s/c or HEPARIN IV or fondaparinux

Question 9

When to give

PCI

Answer 9

Within 120 mints of MI

Question 10

Within what time-frame can alteplase be given ?

Answer 10

4.5hrs

Question 11

Within what time-frame can streptokinase be given ?

Answer 11

12 hrs

Question 12

Streptokinase

Can the dose be repeated or is it a one off?

Answer 12

1 dose within 4 days as

the drug can become ineffective

Question 13

CPR

Tx

Answer 13

30 compressions per 2 breaths
Or
100 compressions per minute

Meds:

Adrenaline IV 1 in 1000 every 3-5 mints

Alternative

IV Amiodarone (if ventricular fibrillation)

Question 14

Stable angina

SE

Answer 14

feels tight, dull or heavy – it may spread to your left arm, neck, jaw or back
is triggered by physical exertion or stress
stops within a few minutes of resting
Sometimes there might be other symptoms, like feeling sick or breathless.

Question 15

Stable angina

What is it

Answer 15

Chest pain due to poor blood supply to the heart muscles

Question 16

Stable angina

Tx

Answer 16

GTN
Spray 1-2 Spray s/L
1 tablet s/L

Take one dose ever 5 mints if symptoms don’t get better MAX 3 doses

CALL 999

Question 17

GTN

Tablet expiry

Answer 17

Special container expired with 8 weeks of opening

Question 18

Isosorbide Dinitrate (MR)

How to take

Answer 18

Swallow BD ( even if MR)

Can be taken s/L

Question 19

Stable angina

If GTN (= nitrate) 
Used how often a week to get long term prophylaxis

Answer 19

Twice or more weekly

Question 20

Stable angina
Long term

Management
(If using GTN more than twice weekly)

(2)

Answer 20

1. BB or CCB
   (Rate limiting ccb CI in LVSD and HF)
2. BB ➕ CCB

( if one or both drugs CI add vascodilator
🟢 ranolazine
🟢 ivabradine (in normal sinus rhythm)

OR NICORANDIL (adults only)

2nd line due to ulcers!
No driving till performance established

Question 21

Ccb

given in angina list
3

Answer 21

Amlodipine
Nifedipine MR
Felodipine

Question 22

Stable Angina
Managment

How many drugs max

Answer 22

2

Question 23

Nitrate
tolerance

problems solved

Answer 23

Don’t use patch at night

Take OD instead of BD

Question 24

Nitrate

SE

Answer 24

Arrhythmias; asthenia; cerebral ischaemia; dizziness; drowsiness; flushing; headache; hypotension; nausea; vomiting