ERC - ACS Flashcards

1
Q

You suspect ACS in a patient but the ECG is normal and markers are all negative. What do you do

A

chest pain observation unit
multidetector computer tomographic angiography MDCTA (good detection but ++ radiation and could overdiagnose)
Echo

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2
Q

What is the pharmacoinvasive strategy of PCI and fibrinolysis

A

Fibrinolysis then PCI 3-4hrs after

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3
Q

What is rescue PCI

A

PCI following unsuccessful fibrinolysis

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4
Q

define unsuccessful fibrinolysis

A

<50% resolution of the ST elevation 90 minutes after fibrinolysis

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5
Q

what is facilitated PCI

A

PCI immediately after fibrinolysis

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6
Q

You get ROSC in a STEMI patient, what next

A

PCI and TTM

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7
Q

You get ROSC in a non STEMI patient, what next

A

very dependant on the patient: downtime, comorbidities, ECG changes, neurological status all factor in to decision if to PCI or not

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8
Q

Describe post ACS care in terms of long term drugs prescribe

A

Bblocker
ACE-i (or ARB)
statin

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9
Q

Where is ST elevation measured from on an ECG

A

J point - termination of QRS and start of ST

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10
Q

What is needed for the diagnosis of STEMI

A

clinical signs and symptoms +
0.1mv rise in 2 adjacent limb leads
0.2mv rise in 2 adjacent chest leads
new LBBB

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11
Q

What would make you suspect an inferior STEMI

A

isolated ST depression in V1-V3 (indicating posterior infarct)
ST elevation in 2,3, AVF

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12
Q

how would you confirm a posterior STEMI

A

ST elevation and Q waves in V7-V9

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13
Q

Which troponins are most cardiac specific

A

T or I

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14
Q

clinical signs and symptoms of ACS + non STEMI ECG changes + troponin +ve = what diagnosis

A

NSTEMI

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15
Q

clinical signs and symptoms of ACS + non STEMI ECG changes + troponin -ve = what diagnosis

A

unstable angina

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16
Q

Which non-STEMI patients are high risk

A
dynamic ECG changes
ST-depression
diabetic
haemodynamically unstable 
use of high risk scores eg TIMI, GRACE
17
Q

Describe some factors that TIMI and GRACE take into consideration

A

TIMI - age, CAD risk factors (diabetes, cholesterol, HTN, FH, smoker), ST changes, cardiac enzymes, angina episodes in past 24 hours
GRACE - age, HR, BP, ST changes, cardiac enzymes, Killip class, creatinine, if they’ve been in arrest

18
Q

What do all ACS patients get regardless of STEMI or NSTEMI

A

Morhpine 3-5mg (repeat until no pain)
Nitroglycerin (GTN) sublingual 0.4mg
Aspirin 300mg chewable

19
Q

What are the contraindications to giving nitroglycerin (GTN)

A

Systolic BP <90
bradycardia
suspected inferior MI

20
Q

Which STEMI patients get PCI and which get fibrinolysis

A

PCI if can get there in 60-90 minutes, in cardiogenic shock, contraindication to fibrinolysis
Fibrinolysis if can’t get to PCI in time

21
Q

What adjunctive treatments do you give to STEMI patients undergoing PCI or fibrinolysis

A

Antithrombin - heparin, enoxaparin, bivalirudin or fondaparinux
Antiplatelet - clopidogrel or ticagrelor

22
Q

What is the dose of clopidogrel in ACS

A

300mg for STEMI patients undergoing fibrinolysis and for non STEMI patients
600mg for STEMI patients undergoing PCI

23
Q

In which patients does prasugrel increase the risk of an intracranial bleed

A

history of stroke or TIA
>75 y/o
<60kg body weight

24
Q

What adjunctive drugs are given to non-STEMI ACS patients

A

antithrombin - heparin or enoxaparin (or fondaparinux if high bleeding risk)
antiplatelet - clopidogrel or ticagrelor

25
What are the advantages of ticagrelor over clopidogrel
Reversible faster not reliant on genetic differences in drug metabolism
26
What class of drugs are clopidogrel, ticagrelor and prasugrel
Adenosine diphosphate (ADP) receptor antagonists
27
What is a late presenter
presenting >3 hours since symptom onset