Acute Coronary Syndrome (ACS)

Question 1

Non-ST-Segment Elevation acute coronary syndrome (NSTEMI)

Answer 1

• There is not a complete occlusion of blood flow within a coronary artery
• Blood flow to a coronary artery is diminished
• Presents as ST Depression or T wave inversion on EKG
• Less serious than STEMI

Question 2

ST-Segment Elevation Myocardial Infarction (STEMI)

Answer 2

• Develops after ruptured plaque or erosion results in an acute blood clot that significantly or completely occludes a coronary artery
• Presents as ST-elevation on EKG (Tombstone)
• PCI needed/preferred
• More serious than NSTEMI

Question 3

Before EMS arrive take this medication:

Answer 3

160-325 mg non-enteric coated aspirin (2-4 baby aspirin or 1 adult aspirin)
-Do not take if allergy or active/current GI bleeding

Question 4

Highest priority assessment tool in determining ACS:

Answer 4

EKG: Determines if NSTEMI or STEMI based on ST-segment behavior

Question 5

Management of ACS symptoms

Answer 5

1. Provide oxygen if sat below 90%
2. Administer ASA if not already done
3. Nitroglycerin
4. Morphine

Remember: ‘MONA’

Question 6

Nitroglycerin dose & monitoring

Answer 6

• 1 dose every 3-5 minutes for a max of 3 doses

- Monitor blood pressure between each dose

Question 7

Contraindications to receiving Nitro

Answer 7

• Severe bradycardia
• Tachycardia
• Phosphodiesterase inhibitors (ED drugs) in the last 24-48 hours
• Right ventricular Infarction (take right-sided EKG)

Question 8

When should Morphine be used? Monitoring?

Answer 8

• When pain relief is not achieved by nitro
• Monitor blood pressure and RR between doses
• Use cautiously in patients with unstable angina

Question 9

Option 1 to reperfusion: What is Percutaneous Coronary Intervention (PCI)?

Answer 9

• Cardiac catheter to open narrowed/occluded artery with balloon to first widen artery, and then stent is placed to keep artery open
• Preferred method to reperfusion with STEMI

Question 10

Goal time to PCI?

Answer 10

120 minutes from first medical contact or 90 minutes from ER to balloon inflation

Question 11

Option 2 to reperfusion: Fibrinolytics

Goal time to administration?

Answer 11

30 minutues

-less desired in compared to PCI with higher mortality rate

Question 12

Adjunctive Treatments

Answer 12

1. Unfractionated or low-molecular weight heparin
2. Bivalirudin (Angiomax):blood thinner-prevents blood clots during angioplasty
3. PSY12 Inhibitors: antiplatelet drugs-clopidogrel/plavix, ticagrelor/brillinta
4. IV Nitro
5. Beta-Blockers-manage abnormal heart rhythms
6. Glycoprotein IIb/IIIa inhibitors:antiplatelet drugs (tirofiban/aggrastat)