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PR - CARDIOVASCULAR SYSTEM > ACS > Flashcards

ACS Flashcards

1
Q

What are Acute
Coronary Syndromes (ACS)?

A
  • Unstable Angina
  • NSTEMI (“Heart attack)
  • STEMI (“Serious Heart attack”)
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2
Q

What is the difference between stable angina and UNSTABLE angina?

A
  • Both occur as a result of restricted blood flow to the heart
  • Stable angina occurs due to physical activity/exertion
  • Whilst in UNSTABLE angina, symptoms occur at rest or during very little activity
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3
Q

NSTEMI

A
  • Non ST segment elevation MI
  • ST segment is not elevated on ECG
  • Partial blockage
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4
Q

Difference between NSTEMI and unstable angina

A
  • Unstable = partial block which can = NSTEMI/STEMI. But heart muscles are preserved
  • NSTEMI = some cardiac necrosis (heart damaged)
  • STEMI = more cardiac necrosis
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5
Q

A partial block of the coronary artery is…

A

NSTEMI OR Unstable angina

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6
Q

STEMI

A
  • Complete blockage of artery
  • ST zone of ECG is elevated
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7
Q

Complications

A
  1. Arrythmias
  2. HF
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8
Q

Diagnosis

A
  • Full clinical history
  • Physical examination e.g. BP and HR
  • ECG (12-lead)
  • Blood tests (including Troponin I and T)
    MAIN ONE!
  • Creatinine
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9
Q

Troponin

A
  • Protein found in heart muscles
  • When damage occurs, it is released into the blood treat
  • High levels of troponin = NSTEMI/STEMI
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10
Q

What are the steps involved in the initial
management of
NSTEMI and UA?

A
  1. Pain relief: GTN +/- IV morphine
  2. Aspirin 300mg loading dose
  3. fondaparinux sodium
    - if bleeding risk is NOT high
    and
    - NOT undergoing immediate coronary angiography
  4. Monitor for
    Hyperglycaemia
    - Give insulin if necessary
  5. Oxygen
    - Only if hypoxia is suspected
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11
Q

Which drugs are given to manage pain in the initial management of
NSTEMI and Unstable angina?

A
  1. GTN
  2. IV Morphine
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12
Q

What if the patient has already administered an aspirin 300mg
loading dose before admission to the hospital?

A

Inform medical team

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13
Q

Why is fondaparinux sodium administered to patients with
NSTEMI or UA in the initial management?

A
  • anti-thrombin
  • NSTEMI and UA occur as a result of thrombus restricting blood flow to the heart
  • prevents thrombus formation
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14
Q

What is an alternative to fondaparinux
sodium if patients have renal impairment?

A

Heparin (unfractionated)

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15
Q

What are the revascularisation procedures used in
NSTEMI and UA?

A
  1. PCI
  2. CABG
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16
Q

PCI

A

Percutaneous coronary intervention
- coronary angioplasty (baloon that inflates to expand blood vessels and stents)
- minimally invasive procedure

17
Q

CABG

A

Coronary artery bypass graft (CABG)
- Taking blood vessels from other parts of the body
- These new blood vessels (graft) are used to deliver blood to the heart and bypasses the blocked or narrowed arteries

18
Q

If patient is undergoing a PCI, which anticoagulant should be administered to them?
Does it matter if they have already received anti-thrombin treatment
e.g. fondaparinux?

A
  • Patients undergoing PCI should be administered
    Heparin (unfractionated)
  • Regardless of whether or not they have received fondaparinux
19
Q

Dual-antiplatelet therapy

A

Following diagnosis, initial management and whether or not revascularisation procedures are given, patients will need a second antiplatelet in addition to aspirin
- Prasugrel
- Ticagrelor
- Clopidogrel

20
Q

In summary, when is Prasugrel offered as a second anti-platelet?

A

ONLY when PCI is indicated!!
P for PCI and Prasugrel

21
Q

What if patient has a high bleeding risk, can they take dual-antiplatelet therapy?

A

Patients can take Aspirin as monotherapy (no dual anti-platelet therapy)

22
Q

What if patients cannot take Aspirin due to hypersensitivity,
which anti-platelet can you offer?

A
  • Clopidogrel monotherapy
23
Q

How long is dual-antiplatelet therapy given for?

A
  • Dual antiplatelet given for 12 months
  • Aspirin should be taken for life
24
Q

What is the dose of Aspirin in ACS?

A
  • On symptom onset (during
    initial management) = 300mg
    loading dose
  • Secondary prevention of CVD
    = 75mg OD
25
Q

Which oral anticoagulant may be considered in combination with anti-platelets for the
prevention atherothro mbotic events following ACS?

A
  • Rivaroxaban 2.5mg BD
  • Taken in combination with Aspirin AND Clopidogrel (or in combination with Aspirin alone)
26
Q

In summary, if patient is already taking an anti-coagulant for another condition, which anti-platelet do you offer in
combination with Aspirin?

A

Clopidogrel
DO NOT OFFER TICAGRELOR OR PRASUGREL IF PATIENT IS
TAKING ORAL
ANTICOAGULANT

27
Q

What should be performed
IMMEDIATELY
following a STEMI?

A
  1. PCI (PREFERRED)
    or
  2. Fibrinolysis
    - Via fibrinolytic drugs e.g.
    Streptokinase
28
Q

How do you determine whether to give PCI or fibrinolysis for reperfusion treatment following STEMI?

A
  • PCl is most preferred method and should be offered within 120 minutes if presented to hospital within 12 hours of symptom onset
  • Offer Fibrinolysis if PCI cannot be offered within 120 minutes if presented to hospital within 12 hours of symptom onset
29
Q

Patients should also recieve dual-antiplatelet therapy following STEMI, which antiplatelet do you offer in addition to aspirin?

A

PCI
- P + A or T + A
Fibrinolysis
- T + A or C+A

30
Q

What are the long-term treatments for secondary prevention of CVD following ACS?

A
  1. Dual anti-platelet therapy
    - for 12 months
  2. ACE-Inhibitors
    - ARB if ACE intolerated
  3. Beta-Blocker
    - May be discontinued after 12m in pt w/o LVEF
  4. Statins
    - ato 80mg

PR - CARDIOVASCULAR SYSTEM (48 decks)

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