ACS

Question 1

ACS symptoms & signs:

Answer 1

** symptoms**
- prolonged cardiac pain.
- Anxiety.
- Nausea and Vomiting.
- breathlessness.
- collapse / syncope.
Signs
- pallor, sweating, tachycardia, nausea.
- hypotension, oliguria, cold peripheries, raised JVP, Third heart sound, Diffuse apical impulse, Lung crepitations.

Question 2

Work up of ACS

Answer 2

1) Repeated ECG ➡️ 1/3 will be normal. Not ❌❌stress test with patient came with chest pain

If we have ST elevation ➡️ ST elevation MI
If no ST elevation ➡️ do cardiac enzyme.

Question 3

Type of MI ?

Answer 3

Anterior ➡️ left coronary artery & left anterior descending (LAD) ➡️V1, V2, V3, V4.

Lateral ➡️ circumflex➡️ l, aVL, V5, V6.

Septal ➡️ left anterior descending (LAD)➡️V1,V2.

Inferior ➡️ right coronary artery(RCA)➡️ II, III, aVF.

Question 4

Cardiac enzyme:

Answer 4

The second step after ECG.

Troponin ➡️ is the Gold standard 4-6 hours last for 10-14 days

Myoglobin ➡️ 1st one to rise 1-4 hours last to 1-2 days

CK-MB 4-6 hours and last for 1-2 days.

Question 5

Management of ACS:

Answer 5

MONA-BASH-C
Morphine
Oxygen
Nitrates
Aspirin
Beta-blockers
ACE-inhibitors
Statin
Heparin
Clopidogrel
Definitive treatment is percutaneous coronary angioplasty (PCI).