ACS mnx

Question 1

A patient presents with ACS initial mnx

Answer 1

Aspirin 300mg, morphine, oxygen, nitrites (careful in low BP)

Question 2

STEMI confirmed what are the options for reperfusion therapy?

Answer 2

PCI or fibrinolysis

Question 3

Eligibility criteria for PCI

Answer 3

Presents with in 12 hours of onset AND PCI available in 120 mins
(Possible to consider if ongoing ischaemia after 12 hrs)

Question 4

When is fibrinolysis used

Answer 4

When PCI cannot be delivered in 120 mins

Question 5

If ST elevation 90 mins after fibrinolysis, what next

Answer 5

Transfer for PCI

Question 6

Antiplatlet prior to PCI

Answer 6

Dual antiplatelet- usually on aspirin
ADD
- prasugrel (pt not taking anti coagulation)
- clopidogrel (pt taking anti coagulation)

Question 7

Drug therapy during PCI

Answer 7

Radial access- UF heparin with bailout glycoproteins inhibitor
Femoral access- bivalirudin with bailout GPI

Question 8

When is fondaparinux given

Answer 8

In NSTEMI and angina, when not having angiography immediately

Question 9

When is UFH given over fondaparinux in NSTEMI and angina

Answer 9

If immediate angiography is planned or creatinine >265

Question 10

When is coronary angiography (plus PCI) indicated in a pt with NSTEMI?

Answer 10

• immediately if pt is unstable
• with in 72hrs if GRACE score >3%

Question 11

Drugs used during PCI in NSTEMI

Answer 11

• UFH regardless if pt has had fondaparinux or not
• add another antiplatlet
  
  • ticagrelor or prasgurel ( not in anti coagulation)
  • clopidogrel (on anticoagulant)

Question 12

Conservative management in NSTEMI/unstable angina

Answer 12

Dual antiplatlets aspirin PLUS
- ticagrelor if not at risk of bleeding
- clopidogrel if at risk of bleeding

Question 13

ECG changes indicating thrombolysis or PCI

Answer 13

ST elevation in 2 or more consecutive leads
- over 2mm in anterior leads
- over 1mm in inferior
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