Acute Coronary Syndrome

Question 1

What are the care objectives in ACS?

Answer 1

1. Rapidly ID STEMI to facilitate timely reperfusion
2. Provision of antiplatelets (aspirin)
3. Reduce cardiac workload by treating associated symptoms

Question 2

What does the spectrum of ACS encompass?

Answer 2

Unstable angina, non-ST elevated ACS and ST elevated myocardial infarction.

Question 3

Which ACS patients may present without pain?

Answer 3

1. Elderly
2. Female
3. Diabetic Hx
4. Atypical presentations

Question 4

Do absent ischaemic changes on an ECg exclude AMI?

How is AMI diagnosed?

Answer 4

No.

AMI is diagnosed through serial ECG’s, serial enzyme tests and presenting history.

Question 5

Spontaneously resolved ACS does not need to be investigated in hospital. True or false?

Answer 5

False.

Question 6

If a lower dose of aspirin has been administered prior to AV arrival, what is the management?

Answer 6

Supplement dose as close to 300mg as possible.

Question 7

Why are nitrates C/I in bradycardia?

Answer 7

Due to the patients inability to compensate for a decrease in venous return by increasing HR to improve cardiac output.

Question 8

What is the equation for cardiac output?

Answer 8

CO = HR x SV

Question 9

How is pain managed in ACS?

Answer 9

Treat with nitrates and if unresolved, treat with opioids. Complete pain removal is not always possible/appropriate.

Question 10

What are the “Assess” priorities in a possible ACS?

Answer 10

1. Determine signs and symptoms
2. Apply 12 Lead within 10 mins
3. Determine any Rx already given

Question 11

What is the STOP note in this guideline?

Answer 11

Request early MICA in ?STEMI and provide early hospital notification.

Question 12

Outline the management for a nauseated NSTEACS patient with SBP 150 and HR 75.

Answer 12

1. Aspirin, 300mg PO
2. GTN 600mcg or 300mcg S/L rpt @5min
3. GTN 50mg patch
4. IV access
5. Morphine <5mg IV rpt @ 5mins
6. Ondansetron 8mg IV

Question 13

What factors influence whether a patient receives 300mcg or 600mcg of GTN?

Answer 13

1. No previous admin
2. Borderline BP
3. <60kg
4. Elderly
5. Frail

Question 14

Within what timeframe is a STEMI able to be treated with pre-hospital STEMI management?

Answer 14

<12 hours.

Question 15

If a STEMI is identified outside of the accepted timeframe, what is the management?

Answer 15

If >12 hours, transmit 12 Lead ECG and provide hospital notification.

Question 16

What is the mechanism of action of nitrates in ACS?

Answer 16

1. Venodilation - promotes venous pooling, reduces venous return to the heart (reduces preload)
2. Arterial dilation - reduces SVR and arterial pressure (afterload)