Acute Medicine

Question 1

What is ACS?

Answer 1

Acute Coronary syndrome = a syndrome where there is reduced blood flow in the coronary arteries causing ischaemia.

Question 2

What is the classification of ACS?

Answer 2

STEMI (>1mm in x2 inferior leads, >2 mm in x2 chest leads, or new LBBB).
NSTEMI
Unstable Angina

(3 classifications).

Question 3

How do we treat a STEMI?

Answer 3

1. ABCDE approach
2. PCI <90 minutes from admission to hospital, <120 minutes if outside of hospital.
3. Thrombolysis if PCI is not available. <30 minutes of presentation.
4. Morphine and GTN for pain
5. Dual antiplatelets (aspirin and ticagrelol)

Question 4

How can we diagnose STEMI?

Answer 4

1. Clinical findings suggestive of ACS
2. ECG changes e.g. subtle T wave changes, inversion
3. Positive troponin.

Question 5

What is the treatment for ACS?

Answer 5

1. Dual antiplatelet therapy (300mg aspirin + 300mg clopidogrel/ 180 Ticagrelol) for 1 year
2. Anticoagulation (Fundaparinox 2.5mg SC OD) for 2-8 days until discharge
3. Long term dual antiplatelet therapy (75mg Aspirin OD + 75mg Clopidogrel OD) (lifelong)

Question 6

What are the five hard risk factors for ACS? (To ask after the presenting complaint).

Answer 6

Smoking?
Diabetes?
Hyperlipidaemia?
Hypertension?
Family history of CAD?

Question 7

Give x4 differentials of chest pain from different systems.

Answer 7

Myopericarditis/ cardiomyopathy
PE
Aortic dissection
Costrochondritis

Question 8

What must you start a patient with unstable angina on in terms of treatment?

Answer 8

Aspirin
Clopidogrel
Fondaparinux (ACF)

Question 9

We give high flow oxygen to individuals with MIs. True or false?

Answer 9

False; high flow oxygen can cause free radical formation.

Question 10

How do you see posterior MI on the ECG?

Answer 10

ST depression in V1-V3.