Acute Coronary Syndrome

Question 1

What are the prinicples of management of a patient with a suspected NSTEMI?

Answer 1

• Presumed cardiac chest pain
  
  • O2, nitrates, morphine, aspirin
• Known NSTEACS (awaiting second troponins)
  
  • Aspirin + clopidogrel, BB/CCB, IV nitrates +/- ACEI
• NSTEMI
  
  • PCI, anticoagulation (LMWH)
  • Aspirin, statin +/- BB/ACEI, cardiac rehab

Question 2

How might you manage someone with stable angina?

Answer 2

• Lifestyle education
  
  • Smoking cessation, exercise, diet modifications
• Background pharmacotherapy
  
  • Antiplatelets - aspirin
  • +/- B-blockade, statin, anti-HT, BGL control
• Consider stenting/bypass
• Acute management
  
  • GTN

Question 3

How might you manage someone with STEMI?

Answer 3

• Presumed cardiac chest pain
  
  • O2, nitrates, morphine, aspirin
• Known STEACS
  
  • PCI (< 90 mins away)
  • Thrombolysis (< 12 hours)
  • Anticoagulation - abciximab, heparin
  • Aspirin + clopidogrel, BB/CCB, IV nitrates +/- ACEI

Question 4

How might you manage a patient with unstable angina?

Answer 4

• Presumed cardiac chest pain
  
  • O2, nitrates, morphine, aspirin
• Known NSTEACS (awaiting second troponins)
  
  • Aspirin + clopidogrel, BB/CCB, IV nitrates +/- ACEI
• Unstable angina
  
  • Aspirin, statin +/- BB/ACEI, cardiac rehab