Acute Coronary Syndrome

Question 1

What are the 3 conditions that fall under ACS?

Answer 1

1. STEMI
2. NSTEMI
3. Unstable angina

Question 2

What is the main biomarker for ACS, and what are its levels for each of the 3 ACS conditions?

Answer 2

Troponin I

STEMI - highly elevated
NSTEMI - slightly elevated
Unstable angina - normal

Question 3

What is the pre-management treatment for ACS?

Answer 3

Remember MONA
Morphine IV - 5/10mg for pain
Oxygen - if levels are <94%
Nitrates - GTN sublingual spray
Aspirin 300mg loading dose

Question 4

Which tool is used to calculate a patients mortality, who is at risk of having a CV event?

Answer 4

GRACE score

Question 5

What is the initial management for a STEMI?

Answer 5

Most dangerous/severe
PCI or fibrinolysis (alteplase/streptokinase) to remove clot
Anticoagulants - LMWH, bivalirudin
Antiplatelets - aspirin/prasugrel

Question 6

What is the initial management for an NSTEMI?

Answer 6

Aspirin 300mg loading dose
Antithrombin therapy - fondapurinix, unfractioned heparin

Question 7

What is the long-term management after an ACS event?

Answer 7

Remember ABAS

Antiplatelet therapy - dual therapy; aspirin 75mg lifelong + clopidogrel 75mg for 12 months
Can also give ticagrelor 180mg STAT, then 90mg BD

B-blockers - bisoprolol, titrated to 10mg

Acei - ramipril, titrated up

Statins - high dose atorvastatin 80mg

GI protection - lansoprazole 30mg OD

Question 8

What are some side effects of b-blockers?

Answer 8

Tremor
Hypoglycaemia
Bronchospasms - avoid in asthmatics
Night terrors
Coldness

Question 9

What should patients avoid when taking atorvastatin?

Answer 9

Grapefruit juice

Question 10

What drugs increase bleeding risk when taken with aspirin?

Answer 10

SSRIs
NSAIDs
Anticoagulants e.g. warfarin, DOACs

Question 11

What are some side effects of ACEi?

Answer 11

Dry cough
Constipation
Hyperkalaemia
Dry mouth