ACS

Question 1

What are the 3 types of ACS?

Answer 1

1. STEMI
2. NSTEMI (troponin high)
3. Unstable Angina (normal troponin)

Question 2

Assessment in ACS

Answer 2

History including Family History

Bedside: ECG

Bloods: FBC, U+Es, Troponin

Imaging: Echo

Question 3

Unstable Angina Management

Answer 3

Oxygen
GTN sublingually
Morphine 2-5 mg IV

+Beta blocker
+ Aspirin and Ticagelor / Clopidogrel

Question 4

NSTEMI Management

Answer 4

PCI: + aspirin and clopidogrel (anti platelet) + heparin (anticoagulation)
+ GTN + morphine + beta blocker

Question 5

STEMI Management

Answer 5

Haemodynamically unstable: PCI + heparin (anticoagulation) + Aspirin 300mg & Ticagrelor 180mg(antiplatelets) + Morphine

Haemodynamically stable:

• Access to PCI within 90 mins: heparin (anticoagulation) + Aspirin 300mg & 180 mg Ticagrelor (anti platelets) + beta blocker (to reduce infarction size) + statin (for plaque stabilisation)
• No access to PCI in 90 minutes but within 12 hours:
  THROMBOLYSIS (Alteplase) + heparin (anticoagulation) + Aspirin and Clopidogrel (NOT ticagrelor in thrombolysis) + beta blocker (reduce infarction size) + statin (for plaque stabilisation)

Question 6

What drugs reduce mortality post heart attack/ MI?

Answer 6

1. Beta blocker
2. ACE inhibitor
3. Statin
4. Aspirin 75mg
5. Clopidogrel / Ticagrelor 90mg