Acute coronary syndromes Flashcards
Symptoms of ACS
Nausea, vomiting, fatigue, band-like chest pain radiating to lower jaw, shoulder, back and left arm. Sweating, sob, and lightheadness/dizziness
Differential diagnosis that mimics ACS?
peicarditis
What is the cause of ACS?
Thrombus formation on plaques in the arteries
ECG findings for NSTEMI?
May be normal or have ST depression and T-wave inversion
ECG findings for STEMI?
ST elevation
What can differentiate an NSTEMI from unstable angina?
Higher levels of troponin
Which condition does unstable angina share a treatment pathway with?
NSTEMI- treat the same
What is the purpose of a GRACE score?
To categorise a patient into low + high risk in non-ST elevated ACS- determines who is for conservative management and who is for an angiogram
What is indicated if significant disease is found in 2+ arteries following an angiogram?
CABG
When is a PCI indicated?
In ACS post-angiogram- should be given within 12 hours of onset of symptoms but within 2 hours of the time when fibronylsis could have been given
When is Fibrinolysis indicated?
If within 12 hours of onset of STEMI and PCI is not an option within next 2 hours
What are the agents used for fibrinolysis?
Alteplase, Tenectaplase, Streptokinase, Urokinase
When is fondarparinux used in ACS?
For NSTEMI/ unstable angina in addition to 300mg aspirin loading dose
Whne is 300mg aspirin indicated in ACS?
All ACS require loading dose of aspirin 300mg
What class of drugs is fondaparinux?
Antithrombin agent- Factor Xa Inhibitor
How long is fondaparinux licensed for in ACS?
8 days maximum- can be stopped prior to this if patient is discharged
If fondaparinux is indicated for ACS but the patient is taking anticoagulation pre-admission, what is the recommend treatment?
Tx dose LMWH as fondaparinux isn’t potent enough in this case.
What CrCl is fondaparinux CI in?
<20ml/min
When is fondaparinux not inidcated in non-ST elevation ACS?
If patient is for PCI
What are the investigations is patient has suspected ACS?
High-sensitivity troponin, ECG, and FBC
How long is triple therapy licensed for and which P2Y12 inhibitor is used?
7 days + clopidogrel
