Acute Coronary Syndromes

Question 1

STEMI Criteria ECG

Answer 1

Changes in 2 or more contiguous leads (same or similar areas of tissue)

MEN >40 STE >2mm V2/3
MEN <40 STE >2.5 V2/3
WOMEN STE 1.5mm V2/V3
STE 1.5mm in other leads

New LBBB

Question 2

STEMI - Medical Management, If not suitable for reprofusion treatment (PCI or Fibrinolysis)

Answer 2

Aspirin + Ticegralor
High Bleeding risk - Aspirin + Clopidogrel

Question 3

When would you offer Fibrinolysis?

Answer 3

Presents within 12 hours + PCI is not available within 120 minutes

Question 4

Fibrinolysis - Explain Management

Answer 4

Fibrinolysis
Anti-thrombin as well
Repeat ECG 60-90 mins

Ticegralor + aspirin
High Bleeding Risk- Aspirin +/- clopidogrel

Progress to PCI if not working

Question 5

When would you offer PCI?

Answer 5

Presents within 12 hours + PCI can be delivered in 120 minutes

Consider if >12 hours but continued MI or cardiogenic shock

Question 6

PCI - Explain Management

Answer 6

Aspirin 300mg stat
+
No oral anti-coagulant: + Prasugrel
Already uses oral anti-coagulant: + Clopidogrel
+
Bailout GPI
(R U Failing Badly?!)
Radial Access: + Unfractionated heparin
Femoral Access: + Bivalirudin

Question 7

NSTEMI Initial Treatment for all

Answer 7

Aspirin 300mg STAT
Fondaparinux (high bleeding risk Unfractionated Heparin)

Then calculate GRACE score

Question 8

NSTEMI GRACE score Low risk treatment?

Answer 8

Consider Conservative Management

Ticegralor (Clopidogrel for higher bleeding risk)

Consider PCI if ischaemia is worsening

Question 9

NSTEMI GRACE score Moderate- High risk treatment

Answer 9

Offer immediate angiography +/- PCI within 72 hours

Pragusel (Only once PCI indicated)
or Ticegralor

If separate indication for anti-coagulant use Clopidogrel

UH in cath-lab if PCI

Drug eluting stent if indicated