Acute coronary syndromes - case studies

Question 1

What is the tx pan for this pt?

Answer 1

initial/emergency: given DAPT and taken directly to cardiac cath lab for primary PCI

Maintenance/further treatment:

• hospitalised for 48-72 hours
• started in DAPT - aspirin and ticagrelor
• high dose statin - atorvastatin 80 OD
• beta blocker - bisoprolol
• ACE inhibitor - ramipril
• request echo to assess LV function

Question 2

What does this ECG show?

Answer 2

ST elevation

after S (the dip) it should be flat to the T wave

It should be on the isoelectric line before T wave

Question 3

In PCI, what does the catheter drip into the artery?

Answer 3

dye - can see where the blockage is

after the surgery - die will flow through artery

Question 4

After a STEMI, how long is the pt in hospital?

Answer 4

48-72 hours

Question 5

Why prescribe high dose statin after PCI?

Answer 5

Prevent further MI regardless of cholesterol level

Question 6

Why prescribe ACE and beta-blocker after PCI?

Answer 6

Treat damage to myocardium from infarction

prevent admission with heart failure

Question 7

Why request echo to assess LV function after PCI?

Answer 7

Primary determinant of prognosis after MI

Question 8

Is this pt STEMI or NSTEMI?

Answer 8

STEMI

Question 9

What is GTN?

Answer 9

vasodilator

Question 10

Why is this case a NSTEMI?

Answer 10

Chest pain

Normal ECG

raised troponin

Question 11

Why is this case an STEMI?

Answer 11

chest pain

ST elevation on ECG

rise in troponin

Question 12

What is the normal troponin level for a women?

Answer 12

16

Question 13

What is the treatment for case 2?

Answer 13

almost same tx plan as case study 1

however, she gets all the medication first, within a day or 2 go to the cath lab for a procedure

Question 14

With NSTEMI, is the artery completely blocked?

Answer 14

no, some blood movement by thrombus