ACS management

Question 1

When do you give oxygen?

Answer 1

If sats under 94%

Question 2

Main drawback of PCI compared with thrombolysis?

Answer 2

Time delay

Question 3

Symptom onset less than one hour at presentation

Answer 3

PCI within an hour

Question 4

Symptom onset 1-3 hours

Answer 4

PCI within 90 minutes

Question 5

Symptom onset 3-12 hours

Answer 5

PCI within 2 hours

Question 6

What might be the benefit to thrombolysis then PCI (pharmacoinvasive/)

Answer 6

lower re infarction and recurrent ischaemia

Question 7

Fondaparinux in PCI?

Answer 7

No benefit

Question 8

If regional hospital and STEMI and can get there within 120 minutes, …

Answer 8

transfer

Question 9

In NSTEMIs, it is having ECG changes or a trop rise that pushes you into the high risk category and go for…

Answer 9

Go for admission, medical therapy, and early angio

Question 10

For the high sensitivity troponin assay, what do you have to make sure?

Answer 10

Two assays
second sent at least 6 hours post pain
look for 20-50% rise

Question 11

What does antithrombin do?

Answer 11

breaks down Xa and thrombin

Question 12

What is an indirect thrombin inhibitor?

Answer 12

UFH

LMWH

Question 13

What is a direct thrombin inhib?

Answer 13

bivalirudin

dabigatran

Question 14

What are the factor Xa inhibs?

Answer 14

Rivarox
Apix
Fondaparinux
LMWH

Question 15

Rivaroxaban after ACS- what happened?

Answer 15

3 fold increase in major bleeding and ICH!

Question 16

What does aspirin do and what does it not do

Answer 16

Partially stops platelet aggregation

Does not stop platelet adhesion
Does not stop platelet secretion

Question 17

What did the cure trial show?

Answer 17

Aspirin + clop better than aspirin alone in ACS.
Reduced stroke
Reduced CV death
Reduced MI

Question 18

Benefit of abciximab over small molecule agents like tirofiban and eptifibaide?

Answer 18

Minimise heparin use
No dose adjustment in renal dysfunction

Though- not receptor specific compared with the other two that are highly specific

Question 19

When might you use Abciximab?

Answer 19

Elective or emergency PCI

Would not use if unstable angina or NSTEMI with PCI
Eptifibatide use in unstable angina and NSTEMI TOO

Question 20

Prasugrel better than clopidogrel except where…

Answer 20

Prior stroke, age over 75, weight under 60 kg

Question 21

Prasugrel major thing about bleeding risk?

Answer 21

Massively increased CABG related major bleeding

Question 22

Ramipril in high risk patients?

Answer 22

Reduced CV death, MI, stroke

Question 23

Simvastatin or pravastatin more risk reduction?

Answer 23

Simvastatin

Question 24

DAPT in high risk people? Ie before their heart attack?

Answer 24

No benefit and may harm according to charisma

Question 25

DAPT 30 vs 12 months post DES?

Answer 25

Dual antiplatelet therapy beyond 1 year after placement of a drug-eluting stent, as compared with aspirin therapy alone, significantly reduced the risks of stent thrombosis and major adverse cardiovascular and cerebrovascular events but was associated with an increased risk of bleeding. Paradoxical increase in non CV deaths

Question 26

What do you actually ablate in flutter ablation?

Answer 26

Tricuspid valve isthmus