Acute coronary syndrome

Question 1

What are the 3 syndromes?

Answer 1

STEMI
NSTEMI
Unstable angina.

Question 2

Management of ACS

Answer 2

Morphing 2.5-5mg IV + antiemetic
Oxygen
Nitrates (2 puffs every 5mins)
Aspirin 300mg
Ticagrelor 180mg 

+ B (metoprolol 5-15mg IV)

Question 3

DIagnosis of ST elevation ?

Answer 3

Raised troponin with ECG changes.

ST elevation of >2mm in 2 continuous chest leads or >1mm in 2 adjacent limb leads.

New onset left bundle branch block (dominant S wave in V1)

Question 4

Anterior MI leads?

Answer 4

V1-V4

Question 5

What artery for anterior MI?

Answer 5

Left anterior descending

Question 6

Inferior MI leads?

Answer 6

II, III, avF

Question 7

Inferior MI artery

Answer 7

Right coronary artery.

Question 8

Anteroseptal MI leads?

Answer 8

V1 - V4

Question 9

What artery for anteroseptal ?

Answer 9

Left anterior descending

Question 10

Anterolateral chest leads?

Answer 10

I, AVL, V5, V6

Question 11

What artery for anterolateral?

Answer 11

Left coronary or circumflex.

Question 12

Posterior MI leads?

Answer 12

ST depression and upright T waves in V1-V3.

Question 13

What artery for posterior MI?

Answer 13

Right coronary artery.

Question 14

Management of STEMI when arrive at hospital?

Answer 14

Deliver PCI within 120mins if presenting within 12 hours of symptom onset.

If not do fibrinolysis.

Question 15

If patient presents outwith PCI time, what do you do?

Answer 15

You do fibrinolyis.

90mins after this do ECG.

If no >50% resolution then take them for PCI.

Question 16

Secondary prevention of MI, 2 drugs?

Answer 16

Beta blockers reduce mortality.

ACE I = prevent cardiac remodelling.

Question 17

Aspirin in MI?

Answer 17

Take 75mg lifelong aftera STEMI.

Question 18

Take ticagrlor for how long after MI?

Answer 18

For minimum 6 months up to one year. 90mg BD.

Question 19

Pericarditis 6 weeks after MI?

Answer 19

Dressler syndrome.

Question 20

Following confirmation of NSTEMI, treat with what?

Answer 20

Beta blockers and Fondaparinux.

Question 21

Following confirmation of non st elevation ACS, what treatments can be offered?

Answer 21

Either LMWH sc or fondaparinux.

Question 22

All people with an acute coronary syndrome get the same initial treatment, what is?

Answer 22

Morphine + antiemetic
Oxygen
Nitrates (2 puffs every 5 mins)
Aspirin 300mg
Ticagrelor (180mg)
\+ 
Beta blocker (misoprolol)