acute coronary syndromes

Question 1

How are acute coronary syndromes classified?

Answer 1

Based on ECG findings -
Patients with persistent ST-segment elevation on ECG are classified as STEMI
Chest pain with NO ECG changes or ST depression are NSTEMI

Question 2

What risk factors will you ask about in the history?

Answer 2

Diabetes 
Hyperlipidaemia 
Hypertension 
Metabolic syndrome 
Renal impairement 
History of IHD
Obesity 
Smoking 
Age 
Family history

Question 3

Why might patients also have sweating?

Answer 3

Due to high sympathetic drive

Question 4

Why might patients present with epigastric pain?

Answer 4

This is atypical and tends to present in older patients

Question 5

What are the first line investigations to order in someone with suspected unstable angina?

Answer 5

12 lead ECG
Troponin
FBC to check for thrombocytopenia to estimate risk of bleeding and also to check for anaemia (common in unstable in angina)
Urea and electrolytes to assess GRACE score

Question 6

What should be given to all patients with suspected ACS?

Answer 6

A single loading dose of aspirin as soon as possible
Assess the patients HAS-BLED score, check if they have hypersensitivity to aspirin
NICE recommends giving fondaparinux as initial drug therapy
Pain relief with GTN, if not effective then give morphine