Green Book - ACS Flashcards
1
Q
Classification of ACS:
A
- STEMI
- NSTEMI
- UA
2
Q
Signs and Symptoms:
A
- Chest discomfort – tightness, heaviness, restriction – lasting for > 15 min
- Radiation to jaw, throat or L arm
- N & V
- Sweating
- Dyspnoea
3
Q
Investigations:
A
- 12 lead ECG every 15 minutes until pain free - then @ 1 hr & 4 hrs after pain resolved
- Bloods – Troponin, FBC, U&Es, LFTs, lipids, CRP, Clotting screen, Glucose
- CXR
- R/O other causes of pain including: Aortic Dissection, PE, etc.
4
Q
Risk Factors:
A
- Increasing age
- Male gender
- FHx of cardiac disease
- HTN
- DM
- Hypercholesterolaemia
- Smoking
-
Physical inactivity
9.Obesity
5
Q
Initial Management ACS:
A
- Oxygen (Target Sats > 94%; COPD 88-92%)
- Anti-emetic
- Diamorphine 2.5-5 m g IV
- GTN 400 mcg S/L (consider infusion if pain persists)
6
Q
STEMI Definition:
A
- ST elevation > 2mm in V1-V6
- ST elevation > 1mm in two contiguous leads (for all other leads)
- New onset LBBB
- Onset <12hrs
7
Q
Referral - Out of hours vs Working hours:
A
Out of hours:
1. Urgent referral to William Harvey Hospital (WHH) for consideration of Primary PCI.
Working hours:
1. Bleep cardiac specialist nurse (777)
8
Q
Management STEMI:
A
- ASA 300mg PO stat
- Ticagrelor 180mg PO stat
or If PCI not possible <120 mins
- Thrombolysis with Tenectoplase
- Consider urgent referral to William Harvey Hospital for rescue PCI
9
Q
Definition NSTE-MI:
A
- Chest pain
- Raised Troponin
+/-
ECG changes including:
4. ST depression OR
5. T wave flattening/inversion (not in aVR or V1)
10
Q
Management NSTE-MI:
A
- ASA 300mg PO stat
- Ticagrelor 180mg PO stat
- Fondaparinux 2.5mg S/C stat
11
Q
If on Warfarin/DOAC for AF or VTE:
A
- Withhold Warfarin/DOAC
- Start Fondaparinux when INR < 2.0
12
Q
If on Warfarin/NOAC for valve prothesis:
A
- Continue Warfarin/NOAC
- Omit Fondaparinux until Cardiology review
13
Q
Secondary prevention - NSTE-MI:
A
- ASA 75mg OD
- Ticagrelor 90mg BD
- Atorvastatin 80mg ON
- ACE inhibitor
- Beta Blocker
