Acute Coronary Syndrome Flashcards
What is the single loading dose of aspirin for STEMI management? (as first line treatment)
300mg
This is the initial dose recommended for antiplatelet therapy.
What is the second antiplatelet option for patients undergoing PCI for STEMI? (not on oral anticoagulation)
Prasugrel
Other options include ticagrelor or clopidogrel depending on bleeding risk.
Which antiplatelet should be used if a patient is taking an oral anticoagulant?
Clopidogrel
This is the preferred choice in conjunction with anticoagulants.
What antiplatelet options are available for patients not undergoing PCI with high bleeding risk?
Ticagrelor OR clopidogrel
These options are considered based on individual bleeding risk profiles.
What is the time frame for primary PCI to be considered in STEMI management?
Within 12 hours of symptom onset and < 120 minutes for procedure
This is critical for optimizing outcomes.
What should patients with STEMI be offered if they present within 12 hours?
Angiography + PCI
This is recommended if primary PCI can be performed within the required time frame.
What treatment is recommended if primary PCI is not possible in < 120 minutes?
Fibrinolysis
This is an alternative approach to restore coronary blood flow.
Name two fibrinolytic drugs used in STEMI treatment.
Alteplase, streptokinase
Other options include tenecteplase or reteplase.
What additional medication should be administered alongside fibrinolytics?
Antithrombin (fondaparinux/UFH)
This helps to prevent further thrombus formation.
When should a repeat ECG be performed after fibrinolysis?
60 – 90 minutes
This is crucial for assessing the effectiveness of the treatment.
What action should be taken if there is residual ST elevation (>50%) after fibrinolysis?
Immediate coronary angiography + PCI
This indicates the need for further intervention.
What is the primary tool used to assess a patient’s risk in unstable angina and NSTEMI?
The Grace Score
The GRACE score assesses the risk of future cardiovascular events and 6-month mortality rate.
What factors are included in the GRACE score?
- Age
- Heart rate
- Systolic BP
- Creatinine
- Cardiac enzymes
- Presence of ST elevation on ECG
- Cardiac arrest on admission
- Killip class (signs of HF)
Killip classes indicate the severity of heart failure.
What is the first step in the management of unstable angina and NSTEMI?
Antiplatelets - aspirin 300mg and second antiplatelet depending on GRACE score
The first antiplatelet is Aspirin 300mg loading, continued indefinitely.
What are the two main antithrombin treatment options?
- Fondaparinux
- Unfractionated Heparin (UFH)
Thrombin converts fibrinogen into fibrin, crucial for clot formation.
When should fondaparinux be offered to patients?
To all patients, unless undergoing immediate coronary OR high risk of bleeding
Fondaparinux is a preferred antithrombin option.
What are the indications for using Unfractionated Heparin (UFH)?
- Significant renal impairment (Creatinine > 265)
- High bleeding risk (CKD, old age, low body weight, relevant comorbidities)
UFH is used in specific patient populations based on risk factors.
What is the immediate management recommendation for unstable patients with NSTEMI/unstable angina?
Offer immediate coronary angiography
This is critical for patients in unstable conditions.
What is the management approach for intermediate/high risk patients (GRACE > 3%)?
Early invasive approach: Perform coronary angiography (+/- PCI) within 72 hours
PCI refers to percutaneous coronary intervention.
What are the options for the second antiplatelet in the early invasive approach?
- Prasugrel (with aspirin as DAPT)
- Ticagrelor (with aspirin as DAPT)
- Clopidogrel (with aspirin as DAPT) if there is a separate indication for ongoing PO anticoagulation
DAPT refers to dual antiplatelet therapy.
What is the recommended management for low risk patients (GRACE < 3%)?
Conservative approach: Consider functional imaging before discharge
If inducible ischaemia, proceed to coronary angiography +/- PCI.
Which second antiplatelet should be offered to low-risk patients?
Ticagrelor (with aspirin as DAPT)
If high bleeding risk, use clopidogrel (with aspirin as DAPT) instead.
What is the recommended dual antiplatelet therapy for secondary prevention?
Aspirin 75mg OD for life and a second antiplatelet depending on management.
*ticagrelor
*clopidogrel
In patients with other vascular disease, what should be continued after one year of DAPT?
Clopidogrel (not aspirin).
