acute coronary syndrome

Question 1

what are the diseases that make up acute coronary syndrome

Answer 1

unstable angina
nstemi
stemi

Question 2

stable angina

Answer 2

there is an atheromateous plaque that is only fatal when the myocardial demand increases

Question 3

unstable angina

Answer 3

there is rupture of the atheroma and there is formation of a thrombus only that there is partial occlusion of the vessel

Question 4

nstemi

Answer 4

occlusion of coronary artery which leads to infarct on the subendocardial myocardium

Question 5

stemi

Answer 5

obstruction of the coronary vessel which leads to a transmural injury

Question 6

goals for therapy for myocardial oxygen supply

Answer 6

increase myocardial oxygen supply
decrease myocardial oxygen demand

Question 7

increasing supply

Answer 7

Coronary vasodilation
Correct hypoxaemia
Stop platelet aggregation
Stop progression to STEMI

Question 8

how to decrease oxygen demand

Answer 8

Reduce heart rate
Reduce blood pressure (afterload)
Reduce preload
Reduce contractility and wall stress

Question 9

what is the initial management of nstemi and unstable angina

Answer 9

M-morphine
O-oxygen
N-nitrates
A-aspirin
C/T/P-clopidogrel/ticagrelor/prasugrel oasis 6 trial.

Question 10

drugs that reduce oxygen demand

Answer 10

bisoprolol
nitrates
ramipril(ace inhibitor)

Question 11

antiplatelets

Answer 11

Aspirin
Thromboxane-A2 inhibitor
Inhibit platelet activation and recruitment

Clopidogrel/Ticagrelor/Prasugrel
Inhibits ADP activation of P2Y12 receptor

Fondaparinux
Synthetic pentasaccharide
Binds to antithrombin III and potentiatesFactor Xa inhibition x300. Neutralization of Factor Xa decreases the conversion of prothrombin to thrombin, which subsequently decreases the conversion of fibrinogen to fibrin. Less clots.

Question 12

goals of treatment of a stemi

Answer 12

open the occluded artery and stop platelet aggregation

Question 13

treatment of a stemi

Answer 13

if not close to a hospital thrombolytics
if close to a hospital angioplasty

Question 14

how do thrombolytics work

Answer 14

converts plasminogen to plasmin which breaks down fibrinogen to fibrin

Question 15

fibrin specific agents

Answer 15

catalyse conversion of plasminogen to plasmin in the absence of fibrin

Question 16

thrombolysis contraindications

Answer 16

Prior intracranial haemorrhage
Known intracranial lesion
Ischaemic stroke within 3 months
Suspected aortic dissection
Active bleeding
Significant closed head trauma (<3 months)