Cardiovascular- Acute Coronary Syndrome

Question 1

How do you diagnose NSTEMI, STEMI, unstable angina

Answer 1

clinical presentation, ECG changes, biochemical cardiac markers

Question 2

Why do unstable and NSTEMIs occur?

Answer 2

atheromatous plaque rupture

Question 3

How does unstable angina present?

Answer 3

stable angina that suddenly worsens, recurring or prolonged angina at rest, new onset of sever angina

Question 4

When is myocardial necrosis seen?

Answer 4

In NSTEMIs, not unstable angina

Question 5

What are the aims of management of NSTEMI/unstable angina

Answer 5

pain relief during acute attack and prevent further cardiac events and death

Question 6

How do you initially manage NSTEMI/unstable angina?

Answer 6

• Oxygen in hypoxic, pulmonary oedema, continuing myocardial ischameia
• Nitrates relieve ischaemic pain- order of thing to try; S/L GTN, IV or buccal GTN, IV isosorbide dinitrate, diamorphine/morphine, metoclopramide.
• Aspirin and clopidogrel (prasugrel if having PCI)
• Heparin/LMWH/fondaparinux
• Beta blocker indefinitely (CI give diltiazem or verapamil)
• Glycoprotein 2b and 3a can be used for high risk patients