ACS

Question 1

Initial Management of NSTEMI

Answer 1

1) Oxygen (if patient is hypoxic, has pulmonary oedema or continuing myocardial ischaemia)
2) Nitrates- to relieve ischaemic pai. Sublingual GTN/buccal/iv GT. If pain persists then morphine/diamorphine by slow IV infusion alongside metclopramide
3) Aspirin loading dose
4) Second antiplatelt (clop/pras/trica)
5) Antithrombin: Fondaparinux sodium or heparin (if Crcl is low)

Glycoprotein inhibitor Eptifibatide can be given with heparin if the patient is at high risk of death or myocardial infarction

Question 2

STEMI

Answer 2

Initial management is similar to NSTEMI
Coronary reperfusion therapy (PCI/fibronlysis) should be delivered ASAP (primary PCI if within 12 hrs of symptom onset and 120 mins of the time when fibrinolysis)
In addition to aspirin, second antiplatlet prasugel if undergoing primary PCI

Question 3

Secondary prevention

Answer 3

1) ACE/ARB- once stable + continued indefinitely
2) BB - Once stable, continued indefinitely if reduced LVEF, may be appropriate to discontinue after 12 months. (Diltazem or verapamil alternative in those without reduced LVEF and Pulmonary congestion)
3) Aspirin - Continued indefinitely, second antiplatlet stopped after 12 months
4) Statin