Acute Coronary Syndromes

Question 1

What are the acute coronary syndromes?q

Answer 1

MI
NSTEMI
STEMI
Unstable angina

Question 2

How do you treat hypoxia?

Answer 2

O2

Question 3

How do you treat ischaemic pain?

Answer 3

GTN/isosorbide dinitrate

IV diamorphine/morphine with metoclopramide

Question 4

What do you use for reperfusion?

Answer 4

Aspirin 300mg + clopidogrel 300mg

PCI or thrombolytic - alteplase within 4.5 hrs, streptokinase within 12 hrs

Question 5

How do you prevent reocculsion?

Answer 5

Parenteral anticoagulant

Question 6

What is the long term treatment for myocardial ischaemia?

Answer 6

SAAB

Statin
ACEi
Aspirin indefinitely
Beta blocker

Clopidogrel (4 weeks for STEMI, 12 months NSTEMI/unstable angina)

Question 7

What do you use for percutaneous coronary intervention (PCI)?

Answer 7

Dual antiplatelet therapy

Aspirin (forever)
Clopidogrel - elective = 1 month, bare metal stent = 12 months, drug-eluting = 12+ months

Question 8

How do you treat unstable angina and NSTEMI in the community?

Answer 8

Dispersible/chewable aspirin 300mg STAT

GTN as required sublingually or spray

Question 9

How do you treat STEMI?

Answer 9

Aspirin 300mg STAT

IV diamorphine/morphine + metoclopramide

Question 10

How many compressions and breaths do you give for CPR?

Answer 10

30 compressions

2 breaths

Question 11

When do you use IV adrenaline?

Answer 11

1 in 1000 every 3-5 mins
Cardiogenic shock

If ventricular fibrillation present then give IV amiodarone