Acute coronary syndrome

Question 1

when do we opt for percutaneous coronary intervention in people with STEMI?

Answer 1

1- if there is a nearby PCI facility OR
2- cariogenic shock OR
3- Age > 75 yrs
4- Absolute contraindications to thrombolysis

Question 2

differentiate between unstable and stable angina?

Answer 2

unstable angina lasts longer than 5 minutes and often not relieved by fast-acting NTG

Question 3

State briefly the management approach of NSTEMI

Answer 3

First:
ASA 160-325 mg chew and swallow STAT
NTG SL unless SBP < 90 mmHg
O2 and morphine

Second:
check the ECG; if NO ST segment ELEVATION on TWO or more adjacent leads then diagnose as NSTEMI

Third:
Acute management of acute NSTEMI include:
O2 PRN to keep SaO2 > 90%
Beta blockers if no C/I, consider CCB if BB is C/I
Heparin [UFH IV; LMWH SC or fondaparinux SC]

Question 4

Provide brief descriptions of the mechanisms of actions of beta blocker; nitrate, CCB in the management of NSTEMI

Answer 4

beta blockers: beta antagonism results in decreased heart rate; decreased contractility; decreased blood pressure
resulting in drop in myocardial oxygen demand

Calcium channel blockers: promote vasodilation; decrease heart rate and cardiac contractility

Nitrates cause reduction in the afterload and preload. Nitrates cause venous and artery vasodilation reducing oxygen demand by the heart while increasing oxygen supply