Acute Coronary Syndrome Flashcards
3 factors affecting prognosis of ACS?
Age, LV function, ST changes
How many hours does it take for troponin to rise?
3
When do troponin levels peak?
24-48 hours
First drug and dose when ACS suspected?
aspirin 300mg
When not to give sublingual glyceryl trinitrate in NSTEMI?
SBP <90 mmHg
When do you give O2 in ACS?
if SaO2 <94%
What analgesic, dose and route of administration do you use in MI?
Morpine, 5-10 mg, IV
What antiemetic do you give in MI?
Metoclopramide 10 mg IV
What is the second anti-platelet given before PCI in STEMI? (x2)
Ticagrelor or Clopidogrel 300 mg loading dose
What dose and for how long do you continue Clopidogrel post STEMI?
75mg/day for 30 days
When do you choose fibrinolysis over PCI in STEMI?
If PCI not available within 120 mins.
What antithrombin treatment do you give to NSTEMI if NO angiography in next 24 hours?
Fondaparinux
If angiography for NSTEMI in next 24 hours what anticoagulant do you give?
Heparin
What do you give as second anti-platelet drug in NSTEMI?
Clopidogrel 300mg
How long do you continue clopidogrel for post-NSTEMI?
12 months
What glycoprotein IIb/IIIa receptor antagonist should patients consider after NSTEMI is intermediate/high risk of CV event or scheduled angiography in next 96 hours?
epitfibatide or tirofiban
Warfarin for three months following what MI?
Large anterior MI
Drugs started post ACS?
1) Aspirin
2) beta-blocker
3) ACEi
4) Statin
how long off driving after successful angioplasty?
1 week
Aspirin MOA?
Inhibits production of thromboxane A2 (antiplatlet)
What antiplatelet has following MOA:
Inhibits ADP binding to its platelet receptor
Clopidogrel
Fondaparinux MOA?
Activated antithromin III - which potentiates inhibition of coagulation factor Xa
What drug has following MOA?
reversible direct thrombin inhibitor
Bivalirudin
Eptifibatide, abciximab, tirofiban MOA?
Glycoprotein IIb/IIIa receptor antagonist
Poor prognostic factors for ACS?
1) age >65
2) History of HF
3) peripheral vascular disease
4) Reduced SBP
5) Killip Class
6) creatinine conc.
7) elevated cardia biomarkers
8) cardiac arrest on admission
9) ST segment deviation
What system estimates 6 month mortality in ACS?
GRACE score - decides treatment for NSTEMI, angiography, Eptifibatide/tirofiban use
Killip class I?
No clinical signs of heart failure
Killip class II?
Lung crackles, S3
What Killip class if patient has frank pulmonary oedema?
Class III
What emergency if categorised as killip class IV?
Cardiogenic shock
Killip Class IV?
Frank pulmonary oedema, SBP <90 mmHg (Cardiogenic shock)
