Acute Coronary Syndrome

Question 1

what is ACS

Answer 1

ischaemia of coronary artery due to a thrombi

Question 2

types of ACS

Answer 2

unstable angina
NSTEMI
STEMI

Question 3

symptoms

Answer 3

chest pain:
S - chest
O - sudden
C - crushing
R - arm, jaw, neck
A - dyspnoea, sweats, vomiting, dizziness
T - constant
E - exercise 
S - very severe

Question 4

investigations

Answer 4

first do an ECG

if abnormal or shows an ST elevation, new left bundle branch - STEMI

if normal or no elevation, do some bloods for troponin
if troponin is normal - unstable angina, if raised - NSTEMI

echo
CXR
CT angiogram

Question 5

what is troponin

Answer 5

protein that is release when there is death of myocytes

Question 6

management of STEMI

Answer 6

Morphine
Oxygen - >94%
GTN
Aspirin - 300mg

STEMI:
presents within 12 hrs:
PCI + dual antiplatelet therapy, unfractioned heparin and GP1

outwit 12 hrs:
fibrinolysis + antithrombin

Question 7

management after attack

Answer 7

aspirin - 75mg
another antiplatelet
ACEI
beta blocker
statin - 80mg

cardiac rehab
lifestyle factors
echo

Question 8

what leads on an ECG can be affected and what vessels do they correspond to

Answer 8

II, III, aVF - right coronary artery
V1-4 - left anterior descending artery
I, V5 + V6 - left circumflex artery

Question 9

what score is sued to estimate hospital mortality and mortality after discharge

Answer 9

GRACE

Question 10

when can PCI be delivered

Answer 10

presents within 12 hrs

active ischaemia ongoing during admission

Question 11

what must be given if patient presents with STEMI and is getting PCI

Answer 11

dual anti platelet therapy

Question 12

management of NSTEMI/unstable angina

Answer 12

MONA
calculate GRACE score

conservative:
dual antiplatelet therapy
fondaparinux (antithrombin) should be given unless high bleeding risk

PCI:
unfractioned heparin
dual anti platelet therapy

Question 13

when should an ECG be done to check if PCI was effective

Answer 13

60-90mins

Question 14

what is seen in costochrondritis

Answer 14

normal ECG and troponin
tender on palpation
pain worse on inspiration

Question 15

when should oxygen be given

Answer 15

<94%

Question 16

what areas of the heart correspond to the different leads on an ECG

Answer 16

aVF, II, III - inferior 
V1+2 - septal
V3+4 - anterior
V5 + 6 - apex
I, aVL - lateral
V7+9 - post/lateral

Question 17

unstable angina long term management

Answer 17

aspirin/statin
GTN
beta
CCB

Question 18

what is a side effect of GTN

Answer 18

hypotension
tachycardia
headache

Question 19

what heart vessel supplies the AV node and what does this mean if there is an infarct present

Answer 19

right coronary artery

arrythmia can occur after infarction

Question 20

what are the rules for antiplatelet therapy

Answer 20

give prasugrel

if high bleeding risk:
ticagrelor

if on anticoagulant:
clopidogrel