Chest Pain Flashcards
What are the investigations for suspected ACS?
- ECG
- Bloods - FBC, U+E, LFT, Troponins, Magnesium, Phosphate, CRP, glucose, lipid profile
- CXR - Look for alternative causes
What are the different types of ACS?
Stemi - st elevation or new LBBB
N-Stemi - troponin rise at 12 hours without ST elevation
Unstable angina - ACS without ST elevation or troponin rise
What is the immediate treatment for ACS?
MONAC Mophine - 10mg in 10mls slow IV titrated to pain + 10mg IV metoclopramide IV Oxygen if less than 94% Nitrates - sublingual GTN PRN Aspirin - 300mg PO loading dose Clopidogrel - 300-600mg PO loading dose
What ACSs should recieve PCI?
Stemi if within 2 hours
N-Stemi or unstable angina:
-Haemodynamically unstable, high ischaemic risk (recurrent pain) - immediate
-Intermidiate or high risk GRACE score - within 3 days
-Low risk GRACE score - treated conservatively
What scoring system should be used to assess risk in ACS?
Grace score tells you 6-month mortality
Looks at age, HR, SBP, creatinine, ST deviation, troponins, cardiac arrest or LVF
When is throbolysis used for ACS?
Rarely used now but if PCI is not availbale within 2 hours
Contraindicated by bleeding disorders e.g. recent surgery, haemorrhagic stroke in last 6 months
What is the long term management of ACS?
-Beta blocker - reduces myocardial demand - for 12 months
-ACE inhibitor - prevents adverse cardiac remodelling
-GTN spray - PRN
Cardiovascular risk reduction:
-Aspirin (lifelong) + Clopidogrel/ticagrelor for 12 months
-Statins
-BP control
-Lifestyle modification