ACS

Question 1

A 70-year-old man presents with a sudden onset of central chest pain, radiating to his jaw and left shoulder. The chest pain occurred an hour ago when he was sitting on a chair after his dinner. He has a past history of hypertension.

On examination, he is alert but appears to be sweaty, nauseous and short of breath. His pulse rate is 120 bpm and his blood pressure is 150/100 mmHg. ECG shows a T-wave inversion and an ST-segment depression in the anterior leads. Troponin levels, which were taken at 3 hours and at 6 hours after the symptom onset were not elevated.

Which of the following is the most likely diagnosis?

Answer 1

unstable angina

Question 2

A 61-year-old woman is admitted to the emergency department after being brought in by her husband. For the past hour she has experienced severe central chest pain. On arrival, she is haemodynamically stable with no signs of heart failure. Her oxygen saturations are 98% on room air, blood pressure 146/90 mmHg. Her past medical history includes hypothyroidism and having a duodenal ulcer 20 years ago. Her only current medication is thyroxine 75mcg OD.

shows depression on ECG

Answer 2

Aspirin + Beta-blocker + IV morphine/GTN as required + Calculate GRACE score

Question 3

differwnces between unstable and stable angina

Answer 3

Unstable angina comes on without triggers, whereas stable angina is often triggered by exercise)

Question 4

1st line angina

Answer 4

75 aspirin, atrovastatin, GTN and BB/CCB

Question 5

treatment for unstable angina

Answer 5

MONA
300mg aspirin

Question 6

STEMI treatment

2hr or not

Answer 6

Within 2hrs ⇒ PCI + Anti-platelet (e.g. aspirin, ticagrelor)

After 2 hrs ⇒ Thrombolysis (e.g. alteplase, streptokinase, tenecteplase)

Note: If patient is experiencing pain/haemodynamically unstable post PCI ⇒ Urgent CABG

Question 7

post stemi post PCI pain what to do

Answer 7

CABG

Question 8

NSEMI treamtent

BATMAN

Answer 8

BATMAN
Beta-blocker
Aspirin 300mg (stat dose)
Ticagrelor 180mg (stat dose)
Morphine
Anticoagulant (e.g. LMWH)
Nitrates (e.g. GTN) to relieve coronary artery spasm

Question 9

driving post MI car or motorbike if had succefusll angioplasty how long

Answer 9

1 week - no need to infrom

Question 10

if MI and no angioplasty or unsuesful jow long before drive

Answer 10

4 week - no need to infrom DVLA

Question 11

bus or coach driver post MI

Answer 11

inform dvla
cannot drive for 6 week

Question 12

what is stable angina and triggered by what and what often relieves it within 10 min

Answer 12

Reduced blood flow to the myocardium as a result of narrowing coronary arteries. This is often triggered by exercise and relieved by rest/GTN spray within 10 mins.

Question 13

sx of stable angina

Answer 13

Sx: Chest pain +/- radiation to the arm/jaw + Dyspnoea + Palpitations + Syncope

Question 14

gold standard stabel angian

Answer 14

CT angiogrpahy

Question 15

treatment for stable angina

Answer 15

GTN
BB eg bisoplol, nifedipine
2. ivarbradine or isosorbide mononitrate

Question 16

A 23 year old male presents to his general practitioner with a 2 day history of intermittent central, sternal chest pain that feels worse when he wakes up and takes a inspires deeply. He is otherwise fit and well with no relevant past medical history and is a regular gym goer taking no regular medications.

On examination his observations are all within normal range and he has normal heart sounds, a clear chest and a soft and non tender abdomen.

What is the most likely cause of this patient’s chest pain?

Answer 16

constocrondritis - NSAID

Question 17

how long no drive post acute mI

Answer 17

1 week

According to DVLA UK guidance, a person who has just had an acute MI and successful angioplasty should be advised to refrain from driving for one week. After one week, the person may be able to return to driving if they have fully recovered and their GP determines that it is safe for them to do so.

24%
4 weeks

This option is incorrect because DVLA UK guidance recommends a driving restriction of four weeks for people who did not undergo any coronary intervention, or if angioplasty was unsuccessful.

Question 18

Upon examination, her heart rate was found to be rapid and there was a rubbing sound on auscultation. ECG shows sinus tachycardia with non-specific T-wave inversion.

Answer 18

myocarditis