Acute coronary syndromes: Myocardial infarction: NSTEMI, STEMI, UNSTABLE ANGINA, CARDIAC ARREST

Question 1

What to give if theres hypoxia?

Answer 1

O2

Question 2

What to give for ischaemic pain?

Answer 2

GTN OR intravenous dinitrate

-> IV diamorphine/ morphine with metoclopramide

Question 3

What to give for reperfusion?

Answer 3

Aspirin 300mg + clopidogrel 300mg

PCI or thrombolytic (altepase within 4.5 hours, streptokinase within 12 hours- avoid 4 days)

Question 4

What to give to prevent re-occlusion systemic and embolisation?

Answer 4

parenteral anticoagulant

Question 5

what to give for long term management for myocardial ischaemia?

Answer 5

SAAB

statin
ace- inhibitor
aspirin indefinitely
beta- blocker

clopidogrel (4 weeks= stemi, 12 months= NSTEMI/ unstable angina)

Question 6

what is Percutaneous coronary intervention (PCI)

Answer 6

s a non-surgical, invasive procedure with a goal to relieve the narrowing or occlusion of the coronary artery and improve blood supply to the ischemic tissue

Question 7

what can pecutaneous coronary intervention be given with?

Answer 7

glycoprotein IIb/ IIa inhibitor

Question 8

What is dual antiplatelet therapy?

(to do with pecutaneous coronary intervention?)

Answer 8

Dual antiplatelet therapy (DAPT) with PCI (percutaneous coronary intervention) is a medical treatment strategy commonly used in patients who have undergone coronary artery stent placement, particularly drug-eluting stents. It involves the use of two different antiplatelet medications to reduce the risk of blood clots forming within the stent, which could lead to complications like stent thrombosis or restenosis

aspirin (forever)
+

clopidrogrel

elective= one month*
bare metal stent= 12 months
drug- eluting stent= 12 months+

• a medical procedure used to treat coronary artery disease (CAD) in a planned and non-emergent manne

Question 9

how to treat unstable angina and NSTEMI?

Answer 9

dispersible/ chewable aspirin 300mg STAT + Note

GTN as required sublingually (0.3- 1mg) or spray (1-2)

Question 10

how to treat STEMI?

Answer 10

dispersible/ chewable aspirin 300mg STAT + Note

GTN as required sublingually (0.3- 1mg) or spray (1-2)

ADD on: IV diamorphine/ morphine + metoclopramide

Question 11

how to treat cardiac arrest?

Answer 11

cardipulmonary resuscitation:
30 compressions: 2 breaths ~ 100 compressions/ min

IV adrenaline
1in in 1000 every 3-5 min
(sympathomimetic ionotropic used in cardiogenic shock)

if ventricular fibrillation present: Iv amiodarone