Acute coronary syndromes

Question 1

What are the three acute coronary syndromes?

Answer 1

• Unstable angina
• NSTEMI
• STEMI

Question 2

The left coronary artery splits into…

Answer 2

• Left anterior descending (LAD)

- Circumflex

Question 3

Which area of the heart is supplied by the…

a) LAD
b) circumflex
c) right coronary artery

Answer 3

a) Anterior
b) Lateral
c) Inferior

Question 4

Describe the initial and definitive management of STEMI

Answer 4

Initial = MONAA

• Morphine
• Oxygen (if required, i.e. sats below 95)
• Nitrates (GTN)
• Aspirin (plus a second antiplatelet e.g. ticagrelor)
• Anticoagulation with fondaparinux

Definitive = PCI (or thrombolysis)

Question 5

What are the complications of MI?

Answer 5

DREAD:

• Death
• Rupture of papillary muscles
• oEdema (HF)
• Arrhythmia
• Dressler’s syndrome

Question 6

What is Dressler’s syndrome? When does this typically occur?

How is it managed?

Answer 6

Pericarditis caused by a local immune response following MI (usually 2-3 weeks later)

Usually managed with NSAIDs. More severe cases may require steroids (prednisolone) and/or pericardiocentesis.

Question 7

Describe the secondary prevention of CVD following an MI

Answer 7

4 A’s:

• Aspirin (+ another antiplatelet e.g. ticagrelor)
• Atorvastatin
• ACEi
• Atenolol