ACS

Question 1

How do we treat NSTEMI/unstable angina?

What if it is then a confirmed NSTEMI?

Answer 1

Admit, bedrest.

ECG (ST depression /T wave inversion) and bloods
Unstable = no troponin rise.
NSTEMI = trop rise.

Aspirin and ticagrlor
Morphine and metoclopramide

Definite NSTEMI = LMWH (fondaparinux).
Calculate grace score - if high risk then in hospital angiogram +-/ stent

Question 2

What are the criteria for a STEMI?

Answer 2

> 1 mm in 2 adjacent limb leads.
2mm in 2 contigous precordial leads.
New LBBB.

Question 3

What is the pattern of troponin release in MI?

Answer 3

released 4-6 hours after the onset of the MI and remain elevated for at least 7 and up to 14 days after.

TnT over 1 is indicative of an MI.

Question 4

What is the pattern of the rise of CK in MI?

Answer 4

cannot detect an increase in CKMB before 8-12 hours. It has usually peaked in 24 hours and falls within 72.

Question 5

What is the early treatment for a STEMI?

Answer 5

diamorphine (morphine 5-10mg) and anti-emetic IV (metoclopramide 10mg).Oxygen - if hypoxic.
Aspirin - 300mg and 180 ticagralor

Get IV access and put on cardiac monitoring.
Urgent cardiology review for angioplasty.
Thrombolysis – if angioplasty not available within 120 minutes. Make sure there are no contraindications and administer.

Question 6

If an ACS patient has undergone thrombolysis for STEMI, what follow up do they need?

Answer 6

ECG after 90 mins, if not greater than 50% resolution, then send for PCI.

Question 7

What should ACS patients be discharged on?

Answer 7

Maintenance = A, T, plus beta blocker (within 42h unless contra), statin and ACE

ETT after 6 weeks and angiography with stent if needed.