ACS Flashcards
ACS: Immediate Management
Initial Management:
CPAIN
C- Call an ambulance
P- Perform ECG
A- Aspirin 300mg
N- nitrate (GTN), use with caution if patient is hypotensive
STEMI: attempt reperfussion of tissue if within 12 hours of onset
PCI - within 2 hours (aspirin and prasugel or clopidogrel if already on oral anticoagulant)
Thrombolysis (eg. alteplase) (and antithrombin drug)
An ECG should be repeated after 60-90 minutes to see if the ECG changes have resolved. If patients have persistent myocardial ischaemia following fibrinolysis then PCI should be considered.
NSTEMI
B- Base descision about PCI on the GRACE Score
A- Aspirin 300mg
T- Ticagrelor 180mg stat dose (clopidogrel if high bleeding risk, on anticoagulant), antiplatelet
M- morphine for pain control
A- Antithrombin with fondaparinux, unless high risk bleed
N- Nitrate (GTN)
O- Oxygen if less than 95%
GRACE SCORE= 6-month probability of death after NSTEMI
3% or less - low risk
more than 3% - medium to high risk - early PCI with 72 hours
Unstable NSTEMI: Immediate Coronary angiography
ACS: Long Term Management
Aspirin 75mg daily
Ticagrelor/Clopidogrel for 12 months
Atorvastatin 80mg daily - check LFTs
ACE Inhibitor (eg. ramipril) - titrated as high as tolerated
Atenolol or beta blocker
Aldosterone antagonist - for those with heart failure
Echocardiogram, cardiac rehabilitation, secondary prevention med
Stable Angina: Management
GTN
Beta-blocker/CCB (verapamil or diltiazem) monotherapy
Beta/blocker + CCB (amlodipine, modified-release nifedipine)
Aspirin
Atorvastatin
ACE Inhibitor, if CKD, diabters or heart failure
avoid verapamil in patients with heart failure
if a patient has an inadequate response to verapamil then adding a long-acting nitrate is a suitable next step
