A.C.S. treatment

Question 1

Percutaneous coronary intervention

Answer 1

• guidewire inserted into femoral artery up to occluded vessel
• Catheter with balloon and stent passed over graft
• Balloon inflated and stent released to open up occluded vessel
• catheter and guide wire removed

Question 2

Thrombolysis

Answer 2

• Mechanism of breaking down blood clot using medication
• Main medications used are serine proteases: break down plasminogen into plasmin which breaks down fibrin and fibrinogen present in blood clots
• Fibrinolytic used: TNK
• Non-fibrin based: Streptokinase

Question 3

Risks associated with thrombolysis?

Answer 3

• Bleeding
• Do not use if: recent stroke, intracranial haemmorage, aortic dissection, intracranial neoplasm
• Do not use if recent surgery and warfarin administered as it is a blood thinner so high chance of them bleeding out

Question 4

When to carry out surgery?

Answer 4

Surgery is best option if Cath lab can be reached in 2 hours
Thrombolysis is also most effective when carried out immediately

Question 5

Anti-thrombolytic drugs

Answer 5

• Heparin: unfractionated or Low Molecular Weight

- Fondaparinux: 2.5 mg

Question 6

Anti-platelet drugs

Answer 6

-Aspirin: 300mg and then reduced to 75 mg
AND
-clopidogrel: 300mg then reduced to 75mg
ADP receptor activated platelet aggregation inhibitor
Blocks glycoprotein IIb/IIIa pathway so prevents crosslinking of fibrin meshworks

treatment administered up to 1 year after episode

Question 7

Treatment plan:

Answer 7

• ACEI
• statins
• beta-blockers

Question 8

How to treat patient when they first arrive in hospital?

Answer 8

• admit
• cardiac monitor with ECG and troponin levels
• GTN for chest pain- vasodilator
• opiates for pain/anxiety
• O2 if sats are low

Question 9

Angiogram risks

Answer 9

• bleeding
• coronary perforation
• MI
• stroke
• dye can affect kidneys

Question 10

Complications post-MI

Answer 10

• arrythmias
• valve problems due to papillary muscle problems
• Cardiogenic shock
• Myocardial rupture

Question 11

Major studies that have proven the effects of thrombolytic therapy?

Answer 11

ISIS-2
GISSI-1
23% reduction in mortality
39% when used with aspirin

Question 12

How to treat sudden cardiac failure?

Answer 12

• fibrillation
• chances decrease by 7-10% every minute
• best chance of success in 3-4 minutes

Question 13

Which medication to avoid

Answer 13

Nitrovasodilators

Question 14

Relieve symptoms

Answer 14

Morphine
Oxygen
Nitroglycerines
Aspirin

Question 15

Improve survival

Answer 15

beta blockers 
ACEI
Anticoagulants: fondaparinux  
Antiplatelets 
Glycoprotein IIB/IIIA receptor inhibitors

Question 16

Glycoprotein IIb/IIIa receptor inhibitors

Answer 16

Integrin complex found on platelets which binds to fibrinogen and activates them
Work on ADP receptors