Acute Coronary Syndrome

Question 1

Pharmacological Management after ACS

Answer 1

• ACEi - Perindopril 2.5mg PO OD
• High dose
• Aspirin 100mg PO indefinitely
• 2nd antiplatelet (Clopidogrel, Prasugrel, Ticagrelor) for 12 months following event.
• High Dose Statins (Atorvastatin 80mg PO OD)
• HF specific Beta blocker - Bisoprolol 2.5mg PO OD / Nebivolol 2.5mg PO OD
  
  • Note HF specific beta blocker also assists with reducing bronchospasm in asthmatics.

Question 2

Causes of elevated Troponin

Answer 2

• Acute Coronary Syndrome
• Cardiac Surgery
• Cardiac Contusion
• Aortic Dissection
• Aortic Valve Disease
• HOCM
• Tachyarrhythmias
• Takotsubo Cardiomyopathy
• Infiltrative disease (Amyloidosis, Haemochromatosis, Sarcoidosis, Scleroderma)
• Inflammatory diseases (Myocarditis)

Non-cardiac
- Rhabdomyolysis
- PE
- Renal Failure
- Critically ill patient (Resp failure, sepsis)
- Extreme exertion