Acute Coronary Syndrome Flashcards
Which leads show ST elevation in an anteroseptal infarct?
V1-4 (LAD)
Which leads show ST elevation in a high lateral infarct?
I, aVL
Circumflex
Which leads show ST elevation in an inferior infarct?
2, 3, aVF
Right coronary artery
What is the time frame for PCI?
Within 12 hours of symptom onset AND PCI can be performed within 2 hours of presentation
What is the initial management of ACS?
Oxygen if sats less than 94%
Aspirin 300mg
Morphine
Nitrates
What is the time frame for fibrinolysis?
Within 12 hours of symptom onset
What antiplatelet therapy is needed following medical management of STEMI?
Aspirin and Ticagrelor
What antiplatelet therapy is needed following fibrinolysis for STEMI?
Aspirin and Ticagrelor
What antiplatelet therapy is needed following PCI for STEMI?
Aspirin and Prasugrel
What medications are prescribed for secondary prevention?
ACE Inhibitor
B-blocker
Statin
Dual anti-platelet therapy (Aspirin for life, second agent for 12 months)
What are the driving rules following ACS?
4 weeks off driving
1 week if successfully treated by angioplasty
What action is needed following fibrinolysis?
Repeat ECG 90 minutes later checking for resolution of ST elevation
What treatment is needed for cocaine induced MI?
IV benzodiazepine
For which patients would Spironolactone be following STEMI?
Symptoms/signs of heart failure or left ventricular systolic dysfunction
What are the features of left ventricular aneurysm as a complication of MI?
Persistent ST elevation
Signs of left ventricular failure
Which coronary artery supplies the AV node?
Right coronary artery
What are the ECG features in posterior MI?
V1-V3 show reciprocal changes:
- Horizontal ST depression
- Tall R waves
- Upright T waves
What is the mechanism of action of Aspirin?
COX1 and COX2 inhibitor
What is the transfusion threshold in ACS?
If Hb less than 80
What is the management of NSTEMI?
Aspirin 300mg
Calculate GRACE score
If >3% -> PCI
If <3% -> Fondaparinux
What are the variables of the GRACE score?
Age
ECG
Renal function
Troponin
What is the most common cause of death following MI?
Ventricular fibrillation (VF)
