Chapter 4

Question 1

What leads are affected in posterior MI?

Answer 1

Reciprocal ST depression in anterior chest leads, most commonly RCA

Question 2

Name some causes of troponin elevation

Answer 2

PE, aortic dissection, myocarditis, HF, arrhythmias, chronic renal failure, sepsis

Question 3

Additional ACS management if undergoing PCI?

Answer 3

Clopidogrel 300-600mg or ticagrelor 180mg

Question 4

Additional ACS management if needs fibrinolysis

Answer 4

Clopidogrel 300-600mg or ticagrelor 180mg loading dose, antithrombin therapy (LMWH, UFH or fondaparinux

Question 5

What are the contraindications to fibrinolysis?

Answer 5

Previous haemorrhagic stroke, ischaemic stroke in last 6 months, CNS damage or cancer, major surgery, trauma or head injury in last 3 weeks, active bleeding, known or suspected aortic dissection, known bleeding disorder, refractory SBP > 180, TIA last 6 months, oral anticoagulants, pregnancy or less than a week PP, traumatic CPR, active PUD, advanced liver disease, IE

Question 6

What is the management of NSTEMI?

Answer 6

IV heparin or subcut LMWH, fondaparinux, aspirin 100mg daily after loading dose, if planned for revascularisation need platelet ADP receptor blocker, start beta blocker, consider ACEi