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PHM BSc - Resus Science > ERC - ACS > Flashcards

ERC - ACS Flashcards

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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
Q

What are the advantages of ticagrelor over clopidogrel

A

Reversible
faster
not reliant on genetic differences in drug metabolism

26
Q

What class of drugs are clopidogrel, ticagrelor and prasugrel

A

Adenosine diphosphate (ADP) receptor antagonists

27
Q

What is a late presenter

A

presenting >3 hours since symptom onset

PHM BSc - Resus Science (29 decks)

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