ACS

Question 1

what are the ECG changes of ACS?

Answer 1

ST elevation or depression
T wave inversion
Q waves
new LBBB

Question 2

ACS - investigations

Answer 2

ECG
GLUCOSE - ?diabetic, aim 4-11
SERIAL TROPONINS
ROUTINE BLOODS
(FBC - ?anaemic ischaemia
U+C - renal failure can cause false + trop; baseline levels needed before ACEis
E - K imbalance arrhythmia  
LFTs - baseline pre statins
lipids)

Question 3

STEMI - initial management

Answer 3

MONA + Clopidogrel 300mg

if <12h - primary PCI - if not poss in 2h then consider alteplase

Question 4

STEMI - long-term management post-MI

Answer 4

A - ACEi
B - beta blocker
C - cholesterol lowering
D - dual antiplatelet (aspirin 75 lifelong + clopi 75 1 year ± PPI)
E - echo to assess LV

Question 5

management of NSTEMI + UA (ie non-stemi acs) - acute + long term

Answer 5

MONA + daily aspirin
risk stratify:

lowest - OP review, ?exercise ECG, ?angio
low - as for low + daily fondaparinux + clopi
≥ mod - daily fondaparinux + clopi, consider angio within 72h of adm

*omit fondaparinux pre angio/PCI - risk groin haematoma