Acute coronary syndrome

Question 1

what is ACS?

Answer 1

unstable angina and evolving MI

Question 2

what are DD for ACS?

Answer 2

Angina 􏰀
􏰀
Peri / endo / myocarditis
􏰀
 Dissection
􏰀
 PE, pneumothorax, pneumonia
􏰀
 Costochondritis
􏰀
 GI: e.g. GORD, spasm
􏰀
 Anxiety

Question 3

at what time should troponin be taken to exclude MI?

Answer 3

12hrs

Question 4

what is required for STEMI diagnosis ?

Answer 4

Typical symptoms + ST elevation

Question 5

what is required for NSTEMI diagnosis ?

Answer 5

Typical symptoms + no ST elevation + +ve trop

Question 6

what is required for UA diagnosis ?

Answer 6

typical symptoms + no ST elevation + -ve trop

Question 7

what is the treatment for STEMI?

Answer 7

PCI or thrombolysis

Question 8

what is the treatment for NSTEMI/unstable angina?

Answer 8

medical + elective angio ± PCI/CABG

Question 9

does STEMI or NSTEMI have a higher mortality ?

Answer 9

STEMI

Question 10

what is the treatment of pericarditis?

Answer 10

NSAIDs - ibuprofen

Question 11

what does the ECG look like for pericarditis ?

Answer 11

saddle shaped ST elevation

Question 12

what are some complications of MI?

Answer 12

death 
pump failure 
pericarditis 
rupture 
arrhythmia 
ventricular aneurysm 
embolism 
dresslers syndrome

Question 13

whats becks triad?

Answer 13

(↓BP, ↑JVP, muffled heart sounds)

Question 14

with what condition is becks triad seen?

Answer 14

cardiac tamponade

Question 15

what MI would cause sinus bradycardia?

Answer 15

RCA inferior MI

Question 16

what causes dresslers syndrome ?

Answer 16

Due to auto-antibodies vs. myocyte sarcolemma.

Question 17

what is the treatment for dresslers syndrome?

Answer 17

NSAIDs

steroids if severe

Question 18

within what time period can PCI be done for STEMI?

Answer 18

<12hrs

Question 19

within what time can thrombolysis be given?

Answer 19

24hrs

Question 20

state three agents that can be used for thrombolysis?

Answer 20

streptokinase, alteplase (rt-PA), tenecteplase

Question 21

how much exercise should someone post MI do?

Answer 21

Exercise: 30min OD

Question 22

when can someone post MI go back to work, have sex, drive?

Answer 22

Work: return in 2mo

􏰀 Sex: avoid for 1mo

􏰀 Driving :avoid for 1mo

Question 23

following a STEMI how long should aspirin and clopidogrel be taken?

Answer 23

Continue clopidogrel for 1mo following STEMI

Continue aspirin indefinitely.

Question 24

for a low risk (No further pain, flat or inverted T waves or normal ECG, negative trop) NSTEMI/UA what follow up should they have after being discharged?

Answer 24

angio, perfusion scan, stress echo

Question 25

following a NSTEMI how long should aspirin and clopidogrel be taken?

Answer 25

Continue clopidogrel for 1yr following NSTEMI

Continue aspirin indefinitely.

Question 26

for a high risk (Persistent/recurrent ischaemia, ST depression, DM, positive trop.) NSTEMI/UA what treatment should they get?

Answer 26

GPIIb/IIIa antagonist (tirofiban)

􏰀 Angiography (±PCI) w/i 96hrs

􏰀 Clopidogrel 75mg/d for one year

Question 27

what assessments can be used to assess the cardiovascular risk to estimate their in-hospital and 6-month to 3-year mortality after a NSTEMI?

Answer 27

GRACE/ TIMI