acs Flashcards
What is a poor prognostic factor related to age?
Age
Older age is often associated with worse outcomes in various medical conditions.
What condition’s history is a poor prognostic factor?
Development (or history) of heart failure
Prior heart failure can indicate a higher risk for adverse outcomes.
What vascular condition is considered a poor prognostic factor?
Peripheral vascular disease
This condition can compromise blood flow and worsen overall health.
What blood pressure level is a poor prognostic factor?
Reduced systolic blood pressure
Low systolic blood pressure may indicate poor cardiac function.
What classification system includes a poor prognostic factor?
Killip class*
Killip class is used to assess heart failure severity and prognosis.
What initial lab value is a poor prognostic factor?
Initial serum creatinine concentration
Elevated creatinine levels suggest impaired kidney function and worse prognosis.
What cardiac condition on admission is a poor prognostic factor?
Cardiac arrest on admission
Patients who arrive in cardiac arrest have a significantly worse prognosis.
What cardiac marker level is considered a poor prognostic factor?
Elevated initial cardiac markers
High levels of cardiac markers indicate myocardial injury and poor outcomes.
What ECG finding is a poor prognostic factor?
ST segment deviation
ST segment changes can indicate ischemia or other cardiac issues, affecting prognosis.
What should all patients with ST-elevation myocardial infarction (STEMI) receive in the absence of contraindications?
Aspirin and a P2Y12-receptor antagonist
P2Y12-receptor antagonists include clopidogrel, ticagrelor, and prasugrel.
Which P2Y12-receptor antagonist is often favored over clopidogrel due to improved outcomes?
Ticagrelor
Ticagrelor has slightly higher rates of bleeding compared to clopidogrel.
What does SIGN’s 2016 guidelines recommend regarding prasugrel?
Consider prasugrel if the patient is going to have a percutaneous coronary intervention
Prasugrel is another P2Y12-receptor antagonist.
What anticoagulant is usually given to patients undergoing PCI?
Unfractionated heparin
Alternatives include low-molecular weight heparin.
According to NICE, when should supplemental oxygen be offered to patients?
To people with SpO2 less than 94% who are not at risk of hypercapnic respiratory failure and to those with COPD at risk of hypercapnic respiratory failure
Aiming for SpO2 of 94-98% for the former and 88-92% for the latter.
What is the gold-standard treatment for STEMI?
Primary percutaneous coronary intervention (PCI)
Thrombolysis should be performed if primary PCI is not available.
Which thrombolytic agent has shown clear mortality benefits over streptokinase?
Tissue plasminogen activator (tPA)
tPA is preferred for its efficacy in mortality reduction.
What is a notable advantage of tenecteplase compared to alteplase?
Easier to administer and has non-inferior efficacy
Tenecteplase has a similar adverse effect profile to alteplase.
How long after thrombolysis should an ECG be performed to assess ST elevation resolution?
90 minutes
An ECG is used to determine if there has been greater than 50% resolution.
What is the recommended action if there is not adequate ST elevation resolution after thrombolysis?
Rescue PCI is superior to repeat thrombolysis
Rescue PCI should be performed if thrombolysis is inadequate.
What does NICE recommend for glycaemic control in patients with diabetes mellitus during acute coronary syndromes?
Use a dose-adjusted insulin infusion with regular blood glucose monitoring
Blood glucose levels should be kept below 11.0 mmol/l.
Are intensive insulin therapy regimes recommended routinely for managing hyperglycaemia in acute coronary syndromes?
No, they are not recommended routinely
DIGAMI regimes (intravenous insulin and glucose infusion) are not routinely suggested.
What are examples of adenosine diphosphate (ADP) receptor inhibitors?
- Clopidogrel
- Prasugrel
- Ticagrelor
- Ticlopidine
These medications are used to prevent platelet aggregation.
What is the main target of ADP receptor inhibition?
The P2Y12 receptor
P2Y12 receptor is crucial for sustained platelet aggregation and stabilization of the platelet plaque.
What are the G-coupled receptors involved in platelet activation by ADP?
- P2Y1
- P2Y12
These receptors mediate the effects of adenosine diphosphate on platelets.
What is the significance of using aspirin in conjunction with ADP inhibitors?
They block different platelet aggregation pathways
This potential synergy has been explored in clinical trials, especially for high-risk patients.
Which ADP inhibitor was previously the most commonly used?
Clopidogrel
Its interindividual variability in antiplatelet effects led to the development of newer agents.
What notable reduction was observed in trials comparing prasugrel and aspirin to clopidogrel and aspirin?
Marked reduction in short- and long-term ischaemic events
This was particularly noted in moderate- to high-risk ACS patients.
What does the current NICE guideline recommend for dual antiplatelet treatment (DAPT) in ACS?
Aspirin (75mg daily) and Ticagrelor (90mg twice daily) for 12 months
This is recommended as a secondary prevention strategy.
What is the recommended aspirin dosage for patients with ACS undergoing PCI?
Aspirin (75-100mg daily)
It should be combined with either prasugrel, ticagrelor, or clopidogrel for 12 months.
What is a notable adverse effect of ticagrelor?
Dyspnoea
This may occur due to impaired clearance of adenosine.
Which proton pump inhibitors interact with clopidogrel?
- Omeprazole
- Esomeprazole
These interactions can reduce the antiplatelet effects of clopidogrel.
What are absolute contraindications for prasugrel use?
- Prior stroke or transient ischaemic attack
- High risk of bleeding
- Prasugrel hypersensitivity
These conditions increase the risk of adverse events.
In which patients is ticagrelor contraindicated?
- High risk of bleeding
- History of intracranial haemorrhage
- Severe hepatic dysfunction
Caution is also advised in patients with acute asthma or COPD.
