ACS

Question 1

Where do you put the 4 ECG coloured limb leads?

Answer 1

Ride Your Green Bicycle

Red (right arm) Yellow (left arm) Green (left leg) Blue (right leg):

Question 2

Which leads are affected in an inferior STEMI? And which coronary artery is occluded?

Answer 2

II, III, aVF

Right coronary

Question 3

Which leads are affected in an anteroseptal STEMI? And which coronary artery is occluded?

Answer 3

V1-V4

LAD

Question 4

Which leads are affected in an anterolateral STEMI? And which coronary artery is occluded?

Answer 4

V4-6, I, aVL

LAD or left circumflex

Question 5

Which leads are affected in a lateral STEMI? And which coronary artery is occluded?

Answer 5

I, aVL +/- V5-6

Left circumflex

Question 6

Which leads are affected in a posterior STEMI? And which coronary artery is occluded?

Answer 6

Tall R waves, V1-2

Left circumflex, right coronary (sometimes)

Question 7

What should your first investigation be if you suspect someone has an MI?

Answer 7

ECG

Question 8

What are the ECG changes in a STEMI?

Answer 8

ST elevation:
> 0.1mV in 2 adjacent limb leads
> 0.2mV in 2 adjacent chest leads

OR (new) LBBB.

Question 9

What is the most appropriate pharmacological management of a suspected STEMI?

Answer 9

Aspirin 300mg PO
Clopidogrel 300mg PO/ticragelor
Enoxaparin 80mg SC (or some other LMWH)

Question 10

What are the indications for a temp pacemaker?
Emergency?
Elective?

Answer 10

Emergency:

• Asystole
• Symtomatic bradycardia not responsive to atropine
• Mobitz type II 2nd degree AV block
• 3rd degree
• Drug OD e.g. digoxin, betablcokers, verapamil

Elective:
- procedures causing bradycardia (cardiac surgery??)

Question 11

What are the indications for a permanent pacemaker?

Answer 11

• fdsfdsfds