ACS

Question 1

Build up of atherosclerotic plaque which restricts the arteries, reducing the supply of blood and oxygen to the heart - WHAT ARE THE TYPES???

Answer 1

• Stable angina
  
  • Accute coronary syndrome
  • Stemis
    -Nstemi

Question 2

Stable Angina is defined by?

Answer 2

predictable chest pain or pressure due to physical exertion or emotional

Question 3

Initial treatment- OF Stable Angina

Answer 3

Can be taken prophylactically or when symptoms arise
Glyceryl trinitrate dose to be taken at 5 min intervals
If symptoms haven’t resolved after 2nd dose - medical emergency

Question 4

Nitrates- need to be discarded within …

Answer 4

GTN sublingual tablets - should be discarded 8 weeks after opening bottle

Question 5

Patients should have a….. to prevent tolerance, second dose - ( addiction to nitrates)- what is the time frame that the nitrate can be given again?? What about in patch transdermal

Answer 5

Patient should have nitrate free period to prevent tolerance
Second dose of nitrate should be given 8 hours after 1st dose is initiated instead of 12
- In transdermal use - patches should be left off for 8-12 hours a day

Question 6

GTN side effects - which group of pts should it be prescribed with caution in?

Answer 6

Dizziness,flushing and headaches
Should be prescribed in caution in elderly due to risk of falls

Question 7

Acute coronary syndrome major factors include…

Answer 7

• Major factors-
  Family history, hypertension ,hyper cholesterol anemia,diabetes,smokingAll syndromes are quite similar in terms of initial and secondary treatment

Question 8

In the hospital …. And … are evaluated to determine….
If STEMI

Answer 8

• ECG and hospital and bio marker evaluated, tests determine if the patient is having unstable angina/NSTEMI or STEMI
  
  • If it is a STEMI - PCI is needed within 2 hours
  • All three syndromes started on secondary prevention

Question 9

Initial management of stemi

Answer 9

Loading dose of aspirin 300mg
GTN +/- IV morphine
O2 if needed

Question 10

What type of ACS IS THIS??

Answer 10

• NSTEMI and Unstable angina = Patrial blockage of the artery
  
  • STEMI - Complete blockage of the artery
  • NSTEMI - ST zone if ecg is not elevated
  • STEMI - ST zone of ecg is elevated

Question 11

Secondary prevention:

Answer 11

1) Aspirin life long OD - (12 month clopidogrel,ticagrelor if others contra)
2) Atorvastatin 80mg OD
3) ACE or ARB
4) Beta Blocker - might be might be discontinued after 12 months in patients WITHOUT Left ventricular HF

Question 12

Patients with NSTEMI may what to consider having a…..

Answer 12

We may consider a PCI to prevent the likelihood of another Myocardial ischaemic attack