ACS

Question 1

What comes under the term ‘ACS’

Answer 1

• Myocardial infarction (NSTEMI/STEMI)
• Unstable angina

Question 2

MI - Hypoxia

Answer 2

Oxygen

Question 3

MI - Ischaemic pain

Answer 3

GTN or IV Isosorbide dinitrate
IV Diamorphine/Morphine with Metoclopramide can also be given

Question 4

MI - Reperfusion

Answer 4

Aspirin 300 mg (stat)
PCI or thrombolytic = altepase (within 4.5 hours) or streptokinase (within 12 hours)

Question 5

MI - Long term management

Answer 5

SAAB
Statin
ACEi
Aspirin (indefinitely)
Beta-blokcer

Clopidogrel
4 weeks = STEMI
12 months = NSTEMI/unstable angina

Question 6

PCI

Answer 6

PCI can be given with glycoprotein IIb/IIa inhibitor.

Stent in coronary artery
DAPT (dual anti-platelet therapy)
Aspirin (forever) + Clopidogrel
- Elective = 1 month
- Bare metal stent = 12 months
- Drug eluting stent = 12+ months

Question 7

Medical emergency in the community - unstable angina/NSTEMI

Answer 7

• Dispersible aspirin 300 mg STAT + note (to say it has been given)
• GTN as required S/L (0.3 - 1 mg) or spray (1-2)

Question 8

Medical emergency in the community - STEMI

Answer 8

• Same as unstable angina/NSTEMI but ADD on IV diamorphine/morphine + metoclopramide