Acute coronary syndrome

Question 1

What is ACS?

Answer 1

3 types of CAD:
- Unstable angina
- NSTEMI
- STEMI

Question 2

What is unstable angina?

Answer 2

Chest pain
At rest or exertion
Ischaemia but no infarction

Question 3

What is NSTEMI?

Answer 3

Heart attack where coronary arteries are partially blocked
ST depression
Pathological Q waves

Question 4

What is STEMI?

Answer 4

Heart attack where coronary arteries are fully blocked
ST elevation

Question 5

What diagnostic criteria differentiates NSTEMI and unstable angina?

Answer 5

Elevated troponin levels

Question 6

What is acute treatment of STEMI?

Answer 6

Primary PCI within 2 hours
Thrombolysis if PCI not available in 2 hours

Question 7

What is involved in PCI?

Answer 7

Catheter inserted in coronary artery and contrast injected to identify blockage
Stent inserted to keep artery open

Question 8

What is involved in thrombolysis?

Answer 8

Inject fibrinolytic medications to dissolve clots
Tpa (tissue plasminogen activator)- alteplase, Tenecteplase, Streptokinase

Question 9

What are antiplatelet agents?

Answer 9

Aspirin- inhibits platelet thromboxane A2 production
P2Y12 ADP receptor antagonists- prevent platelet aggregation and fibrin cross linking

Question 10

What are the types of P2Y12 antagonists?

Answer 10

Clopidogrel
Ticagrelor
Prasugrel

Question 11

What is the acute treatment of NSTEMI?

Answer 11

Betablockers
Aspirin 300mg stat dose
Ticagrelor 180mg/ clopidogrel 300mg
Morphine
Anticoagulant (fondaparinux)
Nitrates (GTN)
Oxygen