ACUTE CORONARY SYNDROME

Question 1

What is acute coronary syndrome

Answer 1

Symptoms resulting from severe acute myocardial ischemia that may or may not lead to myocardial infarction

Question 2

Classification of ACS

Answer 2

STEMI
NSTEMI
Unstable angina

Question 3

Which ACS presents with normal cardiac enzymes

Answer 3

Unstable angina

Question 4

Risk factors for ACS

Answer 4

Obesity
Dyslipidemia
Hypertension
Diabetes
Smoking

Question 5

Cause of ACS

Answer 5

Atherosclerosis of the coronary arteries leading to reduce myocardial perfusion

Question 6

Nature of chest pain in ACS

Answer 6

Sudden onset
Varying degree but often severe and described as tightness, heaviness or constrictive in nature.
Persisting for more than 30 minutes
Not relieved by rest or glyceryl trinitrate
May radiate to the left arm, the neck or jaw

Question 7

Symptoms of ACS

Answer 7

Chest pain
Nausea
Vomiting
Shortness of breath
Fatigue
Loss of consciousness

Question 8

Signs of ACS

Answer 8

Restlessness and apprehension
Diaphoresis
Peripheral or central cyanosis
Confusion in the elderly

Question 8

This may be the only presention of ACS in diabetics and the elderly

Answer 8

Shortness or breath or fatigue

Question 9

Nature of pulse in ACS

Answer 9

thready, fast, irregular, slow or normal

Question 10

Nature of BP in ACS

Answer 10

Blood pressure may be high, low or unrecordable

Question 11

Bilateral crepitations in a patient with ACS suggests

Answer 11

Left ventricular failure

Question 12

Presence of a third or fourth heart sound in a patient with ACS suggests

Answer 12

Heart failure

Question 13

Which cardia enzymes are investigated in ACS

Answer 13

CK-MB
Troponins I and T

Question 13

Investigations in ACS

Answer 13

12-Lead ECG
Echocardiography
Chest X-ray
Cardiac enzymes:
Coronary angiography
Lipid profile
FBC
ESR, CRP
BUE/Cr
RBS
Serum uric acid
Myoglobin

Question 14

Treatment objectives on ACS

Answer 14

To relieve distress and pain
To limit infarct size
To prevent and treat complications
To reverse cardiac remodelling
To prevent re-infarction
To identify and manage modifiable risk factors
To improve quality of life

Question 15

Non-pharmacological management of ACS

Answer 15

Reassurance
Encourage bed rest in first 48 hours
Weight reduction
Cessation of smoking

Question 16

Initial treatment of ACS patients on admission

Answer 16

Oxygen, intranasal, by face mask or nasal cannula
And
Aspirin, oral (chewable), 300 mg stat.
And
Clopidogrel, oral, 300 mg stat.
And
Glyceryl trinitrate, sublingual, 500 microgram stat.
And
Morphine, IV, 5-10 mg stat.
And
Metoclopramide, IV, 10 mg stat.

Question 17

Role of metoclopramide in ACS management

Answer 17

To prevent vomiting induced by
morphine

Question 18

Maintenance treatment following immedately after initial treatment

Answer 18

Aspirin, oral, 75-300 mg daily indefinitely
And
Clopidogrel, oral, 75 mg daily

Question 19

Patients who receive revascularisation
therapy will require clopidogrel treatment for up to……………

Answer 19

12 months

Question 20

Anticoagulation treatment in ACS

Answer 20

Enoxaparin, SC, 1 mg/kg (100 units/kg) 12 hourly

Question 21

Dose of beta blockers used in ACS

Answer 21

Atenolol, oral, 25-100 mg daily
Or
Bisoprolol, oral, 5-20 mg daily
Or
Metoprolol, oral, 50-100 mg 8-12 hourly

Question 22

Role of beta blockers in ACS

Answer 22

Prevention of cardiac arrhythmias
Reduction of myocardial
workload

Question 23

Role of ACEi or ARB in ACS

Answer 23

To prevent cardiac remodelling and improve survival

Question 24

Dose of ACEi/ARBs in ACS

Answer 24

Lisinopril, oral, 2.5-20 mg daily
Or
Losartan, oral, 25-50 mg daily
Or
Candesartan, oral, 4-16 mg daily

Question 25

Dose of statins in ACS

Answer 25

Atorvastatin, oral, 20-40 mg daily
Or
Rosuvastatin, oral, 10-20 mg daily
Or
Simvastatin, oral, 40-80 mg daily.

Question 25

ACEIs and ARBs should be avoided when systolic BP is below

Answer 25

100mmHg

Question 26

Role of statins in ACS

Answer 26

To stabilise the clot and reduce blood cholesterol levels

Question 27

Statin therapy in ACS is indicated based on the lipid profile

Answer 27

False

Question 28

Role of ISDN in ACS

Answer 28

To improve coronary dilatation and reduce myocardial workload

Question 29

Dose of ISDN in ACS

Answer 29

Isosorbide dinitrate, oral, 10 mg 8-12 hourly

Question 30

Complications of ACS

Answer 30

Pulmonary oedema
Cardiogenic shock
Cardiac arrhythmias