ACS Flashcards
Define ACS
Acute coronary syndrome. Any condition brought on by a blockage or reduction of blood to the heart
Define cardiac arrest.
Electrical disorder causing the heart to stop beating
Define angina
Chest pain due to reduction in blood flow to the heart
Define PCI
Percutaneous coronary intervention
2 methods of repurfusion?
Fibrinolysis or PCI
List some common Sx of ACS
Chest pain, shortness of breath, nausea, pain radiating to jaw or neck, indigestion, weakness, etc
First test done for ACS?
12 lead ECG
NSTEMI vs STEMI appearance on ECG?
NSTEMI will be close to normal with slight ST depression. STEMI has a massive elevated section
2 enzymes that indicate MI?
Raised troponin or creatine kinase
If there are no ECG changes but increased troponin or creatine kinase, what could the diagnosis be?
Unstable angina
Which blockage is more concerning and why? A proximal or distal blockage?
Proximal. Because they are higher up, meaning a larger portion of the heart is affected by the blockage
Compare stable angina and ACS
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.
Sublingual GTN is useful when?
Only in stable angina. Will not relieve ACS pain
Why is fentanyl the preferred analgesic to morphine?
Because it doesn’t cause as much reduction in GI motility, meaning subsequent drugs that are given will be absorbed normally
Which medications do the ambulance usually give in ACS?
300mg aspirin and GTN. No thrombolytic.
After the tests confirm an MI, what medications are given?
Ticagrelor (180mg stat) and heparin
On arrival at hospital, what is given for pain for ACS?
25 mcg fentanyl IV
Why are fibrinolytics or PCI used even though the patient is getting heparin and ticagrelor?
Because antiplatelets and anticoagulants cannot break down existing clots, just prevent the formation of new ones
2 fibrinolytic drugs that could be used in ACS?
Alteplase or tenecteplase
Difference between heparin and enoxaparin in renal impairment?
LMWH may need dose reduction because they are really cleared. Heparin is better in severe renal impairment
Other than aspirin and a statin, which drugs are STEMI and NSTEMI patients usually on long term after their event?
A second anti platelet (clopidogrel or ticagrelor) BB or ACE-I Nictotine GTN Acronym = TANGS + AB
Why are patients given long term GTN after an MI?
Because lots of MI patients develop angina
Why is a second anti platelet needed post MI? Why not just aspirin?
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
Why is ticagrelor becoming preferable to clopidogrel
- it doesn’t require CYP3A4 activation (meaning genetic variability is not important)
- it is reversible = easier to stop if bleeding occurs
When can you not use tirofiban?
If a patient has already had thrombolysis (STEMI only)
