Acute coronary syndromes

Question 1

Whatare the 3 biomarkers of MI?

Answer 1

1. ) Tropnins
2. ) Creatine Kinase isoforms
3. )B-type natriuretic peptides (BNP)

Question 2

When would troponin levels rise and what would they indicate?

Answer 2

8-12 hours after MI - indicate muscle damage

Question 3

When would creatine kinase levels rise and what would they indicate?

Answer 3

quick to develop. If you have a second high level when taking a subsequent test it may indicate a further occlusion and the need for revascularisation.

Question 4

When would b-type natriuretic peptides levels rise and what would they indicate?

Answer 4

Used in long-term prognosis of disease

Question 5

What are the aims of treatment of acute coronary syndromes?

Answer 5

1. ) Reduce or relieve symptoms (crushing pain)
2. ) Prevent or limit cell necrosis
3. ) Reduce risk of early death due to arrhythmia or heart failure (risk is increased by build up of necrotic tissue)
4. ) Prevent re occurrence
5. )Limit the development of chronic ischaemic cardiomyopathy and heart failure (long-term prognosis)

Question 6

What are the 4 primary treatments for suspected MI / UNSTABLE ANGINA while awaiting diagnosis?

Answer 6

1. ) GTN - reduce oxygen demand through vasodilation
2. ) Loading dose of aspirin 300mg (unless contraindicated) to reduce further thrombus formation
3. ) Morphine for pain
4. ) Anti-emetic for nausea/vomiting e.g. cyclizine

Question 7

What is the treatment for diagnosed STEMI?

Answer 7

1.) Revascularisation via PCI (if not contraindicated and if can be done within 120 minutes of giving fibrinolytic and within 12 hours of symptoms)

Question 8

What are fibrinolytics?

Answer 8

They simulate the conversion of plasminogen to plasmin = fibrinolysis = breakdown of the fibrin clot into fibrin degradation products.
Fibrinolytic enzymes are given even if PCI cannot

Question 9

What is the treatment for NSTEMI / UNSTABLE ANGINA?

Answer 9

1. ) Loading dose of clopidogrel 300mg + aspirin (if no risk of bleeding)
2. ) Consider CABG/PGI if damage is severe but this is not an emergency can be done in a few days
3. ) Anticoagulants (prevent further thrombus formation)
4. ) Antiarrhythmics for the treatment of LV failure

Question 10

Long term STEMI treatment options

Answer 10

1. ) Low dose aspirin for life and clopidogrel for 6-12 months (anticoagulant if contraindicated)
2. )Statin - even if levels aren’t high
3. ) ACE inhibitor / ARB (prevent another major event and useful if LV dysfunction)
4. )b-blocker
5. ) Aldosterone antagonist = diuretic if LV dysfunction