ACS

Question 1

Define ACS

Answer 1

Acute coronary syndrome. Any condition brought on by a blockage or reduction of blood to the heart

Question 2

Define cardiac arrest.

Answer 2

Electrical disorder causing the heart to stop beating

Question 3

Define angina

Answer 3

Chest pain due to reduction in blood flow to the heart

Question 4

Define PCI

Answer 4

Percutaneous coronary intervention

Question 5

2 methods of repurfusion?

Answer 5

Fibrinolysis or PCI

Question 6

List some common Sx of ACS

Answer 6

Chest pain, shortness of breath, nausea, pain radiating to jaw or neck, indigestion, weakness, etc

Question 7

First test done for ACS?

Answer 7

12 lead ECG

Question 8

NSTEMI vs STEMI appearance on ECG?

Answer 8

NSTEMI will be close to normal with slight ST depression. STEMI has a massive elevated section

Question 9

2 enzymes that indicate MI?

Answer 9

Raised troponin or creatine kinase

Question 10

If there are no ECG changes but increased troponin or creatine kinase, what could the diagnosis be?

Answer 10

Unstable angina

Question 11

Which blockage is more concerning and why? A proximal or distal blockage?

Answer 11

Proximal. Because they are higher up, meaning a larger portion of the heart is affected by the blockage

Question 12

Compare stable angina and ACS

Answer 12

Stable angina = a slow process (years) with episodic pain lasting 5-15 min provoked by exertion. ACS = sudden, occurs at rest, pain lasts more than 10 min.

Question 13

Sublingual GTN is useful when?

Answer 13

Only in stable angina. Will not relieve ACS pain

Question 14

Why is fentanyl the preferred analgesic to morphine?

Answer 14

Because it doesn’t cause as much reduction in GI motility, meaning subsequent drugs that are given will be absorbed normally

Question 15

Which medications do the ambulance usually give in ACS?

Answer 15

300mg aspirin and GTN. No thrombolytic.

Question 16

After the tests confirm an MI, what medications are given?

Answer 16

Ticagrelor (180mg stat) and heparin

Question 17

On arrival at hospital, what is given for pain for ACS?

Answer 17

25 mcg fentanyl IV

Question 18

Why are fibrinolytics or PCI used even though the patient is getting heparin and ticagrelor?

Answer 18

Because antiplatelets and anticoagulants cannot break down existing clots, just prevent the formation of new ones

Question 19

2 fibrinolytic drugs that could be used in ACS?

Answer 19

Alteplase or tenecteplase

Question 20

Difference between heparin and enoxaparin in renal impairment?

Answer 20

LMWH may need dose reduction because they are really cleared. Heparin is better in severe renal impairment

Question 21

Other than aspirin and a statin, which drugs are STEMI and NSTEMI patients usually on long term after their event?

Answer 21

A second anti platelet (clopidogrel or ticagrelor)
BB or ACE-I
Nictotine 
GTN 
Acronym = TANGS + AB

Question 22

Why are patients given long term GTN after an MI?

Answer 22

Because lots of MI patients develop angina

Question 23

Why is a second anti platelet needed post MI? Why not just aspirin?

Answer 23

Ticagrelor or clopidogrel are used in addition to aspirin because their MOAs are different to aspirin, meaning they increase antiplatelet activity. Particularly useful in preventing a clot from forming on the new stent

Question 24

Why is ticagrelor becoming preferable to clopidogrel

Answer 24

• it doesn’t require CYP3A4 activation (meaning genetic variability is not important)
• it is reversible = easier to stop if bleeding occurs

Question 25

When can you not use tirofiban?

Answer 25

If a patient has already had thrombolysis (STEMI only)