ACI

Question 1

What is acute ischaemia

Answer 1

• Stable angina
• Acute Coronary Syndrome (ACS)

Question 2

What is acute coronary syndrome

Answer 2

• Unstable angina
  -Non-ST elevation myocardial infarction-
  -ST elevation myocardial infarction

Question 3

What is stable angina

Answer 3

Presence of atheroma plaque at rest vessel size sufficient to meet O2 demands

Question 4

What are the risk factors for cardiac ischaemia

Answer 4

Diabetes, hypertension, obesity and smoking

Question 5

How is acute cardiac ischaemia identified

Answer 5

The Drs
(Triggers)- emotional/ exertion
(History)- angina
(Episode)
(Duration)- when it resolves
(Resolution)- resolves with rest/ fast response to GTN
(Severity)- pain typical

Question 6

What is the management of acute coronary syndrome

Answer 6

• 2 activations of GTN (4 left) was
  -300mg of aspirin
  -call 999
  -O2 if SpO2 <94%- simple face mask

Question 7

The management of Stable angina

Answer 7

1. Rest & reduce oxygen demand
2. GTN (dilates blood vessels) 1-2 spray at 5 minute intervals max 6
   - Use ABCDE to monitor

Question 8

What are the contraindications of GTN

Answer 8

• Allergy to nitrate
  -Pregnancy
• Viagra (sildenafil)
• mitral stenosis
• obstructive cardiomyopathy
  -HYPOtensive

Question 9

How do you deliver GTN

Answer 9

1. hold bottle. do NOT shake
2. Activate the pump into air
3. Position patient so can spray under their tongue & place upright bottle
4. instruct patient not to breath when activate
5. Tongue is raise, press and deliver sublingual
6. Instruct the patient to close their mouth

Question 10

When do you prescribe oxygen to an ACI pt

Answer 10

SpO2: <94%
-5-10l/min simple face mask
(history of COPD give 1-2 l/min via nasal cannula)

Question 11

How to differentiate ACI from asthma

Answer 11

ACI:
- Chest pain

Asthma:
- Wheeze
-prolonged expiratory phase

Question 12

How to differentiate ACI from Hyperventilation

Answer 12

ACI:
-Decreased oxygen saturations
-Central/ peripheral cyanosis
- Confusion/ reduced consciousness
-Arrythmia
-Hypotension (rare)

Hyperventilation:
- Normal oxygen saturation
- Lip/ mouth tingling
-Tinnitus
-Blotchy rash
- Carpopedal spasm
-Involuntary muscle spasm

Question 13

How to differentiate ACI from anaphylaxis

Answer 13

ACI:
- Chest pain
-Pale & clammy

Anaphylaxis:
-wheeze
-angiodema
-urticarial/ erythematous rash
-Hoarseness
-Lip/ mouth tingling
-Diarrhoea
-Vomiting

Shared features:
-decreased oxygen
-high HR
-High RR
-Anxiety
-Central/ peripheral cyanosis
-Confusion/ reduced. consciousness
hypotension

Question 14

How does stable angina differ to ACS

Answer 14

Trigger: stable angina (obvious), ACS( Unclear)
History: stable angina (known angina) ACS (No previous)
Episodes: stable angina (no increased frequency of epsiodes). ACS (increased frequency of episodes)
Duration: angina (symptoms resolved in less than 15 mins) (ACS) symptoms excess 15 mins
resolution: angina may resolves with rest/ GTN (under 4). ACS (Slow or minimal response)

Severity: stable angina (pain typical). ACS (severity is worse than typical)

Question 15

When do you call 999 if suspect acute cardiac ischaemia

Answer 15

• first time with chest pain
  -any features of ACS
• Not improving/ worsening after treatment
  -pt treated for hypoxia

Question 16

What do you do if you reassess the pt after giving x2 GTN activations and they arent getting better?

Answer 16

2 more activations
- every 5 minutes up to 6 doses

• if epsiode is in excess of 15 mins, minimal response to 4GTN, Give 300mg of aspirin and call 999