ACS Flashcards
Non-modifiable risk factor for ACS
Age, male, FH
Non-modifiable risk factor for ACS
Age, male, FH
Modifiable risk factors for ACS
HTN, DM, high cholesterol, obesity, smoking
Types of angina
Stable, unstable
Decubitis (lying down)
Prinzmetal’s variant (coronary spasm)
Syndrome X - no evidence of atherosclerosis
Low likelihood of CAD Ix
CT calcium scoring
High likelihood of CAD Ix
Coronary angiography
30-60% likelihood of CAD Ix
Functional imaging:
Stress echo
Myocardial perfusion scan + SPECT, MRI for wall motion abnormalities
Prevention cardiovascular event
Aspirin, statins
Antihypertensive - ACE I
Anti-anginal medication
GTN +
1. Beta blocker
2. Ca blocker (rate control - verapamil)
If not controlled then: 1 or 2 + dihydropyridine
Anti-anginal medication if still not controlled
Ivabradine
Nicorandil
Ranolazine
STEMI acute management
MONARCH
Gold standard reperfusion for STEMI
Primary PCI
Perform PCI within how many hours
12
Thrombolysis CI after how many hours
24h
Modifiable risk factors for ACS
HTN, DM, high cholesterol, obesity, smoking
Types of angina
Stable, unstable
Decubitis (lying down)
Prinzmetal’s variant (coronary spasm)
Syndrome X - no evidence of atherosclerosis
Low likelihood of CAD Ix
CT calcium scoring
High likelihood of CAD Ix
Coronary angiography
30-60% likelihood of CAD Ix
Functional imaging:
Stress echo
Myocardial perfusion scan + SPECT, MRI for wall motion abnormalities
Prevention cardiovascular event
Aspirin, statins
Antihypertensive - ACE I
Anti-anginal medication
GTN +
1. Beta blocker
2. Ca blocker (rate control - verapamil)
If not controlled then: 1 or 2 + dihydropyridine
Anti-anginal medication if still not controlled
Ivabradine
Nicorandil
Ranolazine
STEMI acute management
MONARCH
Gold standard reperfusion for STEMI
Primary PCI
Perform PCI within how many hours
Less 12h
Thrombolysis CI after how many hours
24h
Thrombolysis agents
Streptokinase, altekinase, tenecteplase
Continuing therapy post-MI
ACE I, B blocker, cardiac rehab, statin
How long before can drive and work post MI
1 and 2 months respectively
NSTEMI acute management
MONARCH + GRACE/TIMI
High risk following TIMI/GRACE
GPIIb/IIIa antagonist (tirofiban)
Angiography + PCI
Clopidogel 75mg one year
Low risk following TIMI/GRACE
Continuing therapy post MI
Post MI complications
DARTH VADER Death Arrythmia Ruptured myocardium Thrombus Heart failure Ventricular aneurysm Another MI Dresslers (2-10 weeks post) Emboli Regurgitant murmur (MR)
