Acute Coronary Syndrome Flashcards
Identify three risk factors for ACS
- Smoking
- Hypertension
- Diabetes
- Obesity
- Hypercholesterolaemia
- Male gender
Identify three clinical features of ACS
- Rapid onset chest pain that is severe and lasts longer than 15 minutes
- Referred pain to arms, back or jaw
- Dyspnoea
- Sweating
- Nausea
- Vomiting
- Pallor
How is STEMI diagnosed using ECG?
- More than 1 mm ST elevation in at least two limb leads
- More than 2 mm ST elevation in at least two chest leads
Outline the evolution of the ECG in STEMI
- ST elevation initially
- Tall pointed T wave in first few minutes
- T wave inversion and Q wave development in first few hours
- ST segment returns to normal after a few days
- T waves return to normal after a few days
Which leads demonstrate ST elevation in an anterior wall STEMI?
- V1 - V3
Which leads demonstrate ST elevation in a lateral wall STEMI?
- 1
- aVL
- V4-V6
Which leads demonstrate ST elevation in an inferior wall STEMI?
- 2
- 3
- aVF
What is seen on an ECG in a posterior wall MI?
- ST depression in V1-V3
- Tall R wave in V1
- ST elevation in V5 - V6
What is seen on an ECG inn an anterolateral wall MI?
- ST elevation, Q waves, Inverted T waves
- Leads I, aVL, V2-V6
How do serum troponin levels change following MI?
- Detectable after 3-6 hours
- Peaked at 12-24 hours
- Elevated for up to 2 weeks
Identify 3 other conditions that can raise troponins
- Arrhythmia
- Pericarditis
- Pulmonary embolism
When and how is oxygen administered following a STEMI?
- SpO2 < 94%
- Simple face mask and flow rate of 5-10 L/min
- Target oxygen saturations of 94-98%
Identify 2 medications that can be given to relieve pain following STEMI?
- Intravenous diamorphine hydrochloride
- Sublingual GTN spray (3 doses) followed by IV GTN
Identify two initial medications administered following STEMI
- Aspirin 300 mg
- Clopidogrel 300 mg
Why should patients undergo coronary angiography and PCI?
- Prevent appearance of Q waves
When should coronary angiography and PCI be performed?
- Within 12 hours of symptom onset
- Within 120 minutes of the time when fibrinolysis
Identify a medications that should be given to patients who are to undergo PCI
- Unfractioned heparin
When should fibrinolysis be administered?
- Within 12 hours of symptoms onset
- When PCI cannot be deliveree within 120 minutes
Identify two fibrinolytic agents
- Alteplase
- Streptokinase
Identify a contraindication to streptokinase
- Previous streptokinase therapy
Identify a medication used for patients who are ineligible for reperfusion therapy with either PCI or fibrinolysis
- Fondaparinux sodium
Identify two drugs to offer when the patient is haemodynamically stable
- Ramipril
- Bisoprolol
Identify a drug used in the management of STEMI in patients with heart failure and left ventricular dysfunction
- Spironolactone
Identify a program used for patients following a STEMI
- Cardiac rehabilitation with an exercise component
Identify three lifestyle changes following a STEMI
- Diet consists of more fruit and vegetables, fish, and less meat, butter and cheese.
- 20 - 30 minutes of moderate exercise daily
- Smoking cessation
How long should people wait before return to work post STEMI?
- 2 months
- More time is needed for physically demanding jobs
How long should people avoid sexual activity post STEMI?
- 4 weeks
How long should patients avoid air travel?
- 2 months
Identify three differential diagnoses of a STEMI
- Unstable angina
- NSTEMI
- Aortic dissection
- Pulmonary embolism
- Pneumothorax
What is found on ECG with NSTEMI?
- T wave inversion greater than 1 mm in at least 2 leads
What is found on ECG in unstable angina?
- ST segment depression while the patient has pain
What is the first line medication for NSTEMI and unstable angina?
- Aspirin
- Clopidogrel if aspirin hypersensitivity
What is the GRACE score?
- Tool to assess risk of adverse cardiovascular event following NSTEMI or unstable angina
Identify the management of a patient following NSTEMI or unstable who have a low risk of future adverse cardiovascular events based on the GRACE score
- Dual anti-platelet therapy with aspirin and clopidogrel 300 mg
Identify the management of a patient following NSTEMI or unstable who have a intermediate or high risk of future adverse cardiovascular events based on the GRACE score
- Add intravenous eptifibatide or tirofiban
When is coronary angiography and PCI considered in patients following NSTEMI or unstable angina?
- Low risk patients if ischaemia is subsequently experienced or demonstrated
- Intermediate or higher risk patients within 96 hours of admission
Identify three adverse effects of aspirin
- GI ulceration and haemorrhage
- Bronchospasm
- Tinnitus
Identify three contraindications of aspirin
- Children under 16 due to risk of Reye’s syndrome
- Aspirin hypersensitivity
- Third trimester of pregnancy
Identify two adverse effects of clopidogrel
- GI upset
- Thrombocytopenia
Identify one contraindication of clopidogrel
- Active bleeding
