acute coronary syndrome

Question 1

STEMI definition

Answer 1

“STEMI occurs when a coronary artery or one of the smaller branches that supplies blood to the heart becomes suddenly blocked by a blood clot, causing the heart muscle supplied by the artery to die”

Question 2

NSTEMI/angina definition

Answer 2

In unstable angina and NSTEMI the blood clot causes a reduced blood flow, but not a total blockage so the heart muscle supplied by the affected artery does not die.

Question 3

significant history of MI patient

Answer 3

prev admission w chest pain or cardiac issue

cardiac condition + medication

DM

operations on heart

allergies

Question 4

symptoms of MI

Answer 4

SOB
Cyanosis
Palpitations
clammy
sweaty
Nausea
impending sense of doom
chest pain - tight, radiating to jaw or L arm, >15min

Question 5

signs of MI

Answer 5

dyspnoea
pale
Raised JVP
Hypotensive
Tachycardia

Question 6

if concerned for patients ventilation, what investigation?

Answer 6

ABG

XRAY

Question 7

blood tests for suspected MI

Answer 7

FBC
U+Es
Calcium
Mg
Glucose
Troponin
VBG

Question 8

STEMI ECG changes

Answer 8

new ST elevation

new left bundle branch block + chest pain

Question 9

NSTEMI ECG changes

Answer 9

New ST depression

Deep T wave inversion

Question 10

unstable angina ECG changes

Answer 10

no specific ECG changes

Question 11

immediate management of STEMI

Answer 11

analgesia 
nitrate
aspirin 
ticagrelor
LMWH

MONA - Morphine, Oxygen (not always), Nitrate, Aspirin

Question 12

MI analgesia

Answer 12

titrate morphine 2.5-`10mg slow IV bolus

Question 13

MI nitrate

Answer 13

GTN if BP >90

500mg sublingual
200-800 microgram spray sublingual

repeat after 5 min - max 3 doses

Question 14

MI aspirin

Answer 14

300mg oral

Question 15

MI ticagrelor

Answer 15

180mg oral

Question 16

MI LMWH

Answer 16

subcut

Question 17

STEMI referrals

Answer 17

discuss senior member
contact critical care outreach team
refer to cardiologist for PCI, thombolysis
consider referral to ICU

Question 18

when PCI in STEMI

Answer 18

within 12hrs of onset of pain

if not, consider thrombolysis

Question 19

what if patient not in hospital wherePCI can be done?

Answer 19

blue light transfer to primary PCI centre

Question 20

when consider ICU in MI?

Answer 20

failure to respond to medical management

patient requires ventilator support

patient required blood pressure support

deterioration of blood gas following medical management

Question 21

immediate management of NSTEMI

Answer 21

NATAL
analgesia 
nitrate
aspirin 
ticagrelor
LMWH

Question 22

referrals for NSTEMI

Answer 22

dicuss senior member
contact cirtical care outreach team
refer to cardiologist if pain continues or dynamic ECG changes
consider ICU referrl

Question 23

further management of MI

Answer 23

consider:

• dual antiplatelet therapy (aspirin and ticagrelor)
• ACEi
• beta blocker
• statin

lifestyle advice
cardiac rehab