Introduction And MISCELLANEOUS

Question 1

Main mediator for chest pain in ACS

Answer 1

Adenosine through stimulaton of Alpha 1receptors

Question 2

Risk Factors

Answer 2

Age
Family history Gender
Race
Obesity
Cigarette smoking
Diabetes
Hypertension

Question 3

How s plaque formed

Answer 3

An injury to the endothelium, making site compromised
Deposition of fatty streaks

Question 4

Recumbent position

Answer 4

the recumbent position (lying flat on the back) is generally not recommended, especially if the patient is experiencing acute pulmonary edema, dyspnea, or has orthopnea (difficulty breathing while lying flat).

Question 5

Approved resting position

Answer 5

Semi-Fowler’s Position: This involves elevating the head of the bed to an angle between 30 and 45 degrees.

Question 6

Gold standard from Attakora

Answer 6

Coronary Angiography

Question 7

Management of variant angina

Answer 7

CCB long acting

Question 8

Variant angina means

Answer 8

Coronary Artery spasms even at rest causing chest pain

Question 9

Why are beta blockers CI in variant angina, although it’s mainstay treatment in CAD

Answer 9

They cause vasoconstriction, exacerbating spams

Question 10

Management of SIHD

Answer 10

Antiplatelets : Aspirin and Clopidogrel (both or monotherapy)

Antianginal : Beta-blockers, CCB(DHP or NDHP ), Statins, Long acting nitrates, Short acting nitrates

Question 11

Management of SIHD

Answer 11

Antiplatelets : Aspirin and Clopidogrel (both or monotherapy)

Antianginal : Beta-blockers, CCB(DHP or NDHP ), Statins, Long acting nitrates, Short acting nitrates

Question 12

Acei role in sihd

Answer 12

Has additional heart benefits, same as Statins

Question 13

beta blockers should be used with caution in diabetes?

Answer 13

1. Insulin release is under sympathetic activation, beta blockers will inhibig sympathetic activation causing hyper by reducing insulin
2. Mask hypoglycaemia effects

Question 14

Conditions where Beta-blockers are CI

Answer 14

1.Decompensated HF
2. Heart block 2nd and 3rd degree
3. PERIPHERAL ARTERIAL DISEASE
4. Asthma
5. Bradycardia

Question 15

Most common complication of ACS or MI causing death is

Answer 15

Ventricular fibrillation

Question 16

Management of STEMI

Answer 16

1.PCI ( within 90mins or 120mins upon contact with medics) - door to needle

Alteplase fibrinolytics within 30mins of arrival

Note : MONA is given first as supportive therapy

Question 17

For secondary prevention of ACS

Answer 17

1. Aspirin - 75mg with Clopidogrel 75mg for 12months
   *then Monotherapy of Aspirin indefinitely
   * Cont. DAPT in patients with low risk of bleeding
2. NTG prn
3. Statin
4. Beta blocker of choice- Atenolol, Metoprolol succinate, Carvedilol
5. Acei

Pain consideration: Para, tramadol before considering NSAIDS

Question 18

High dose Aspirin is given prereferal for?

Answer 18

To acetylate already formed clots, 300mg stat

Question 19

Administration of Alteplase bnf

Answer 19

Initial IV bolus of 15 mg over 1–2 minutes.
Followed by 0.75 mg/kg (maximum 50 mg) over the next 30 minutes.
Then 0.5 mg/kg (maximum 35 mg) over the following 60 minutes.
Total Maximum Dose: Not to exceed 100 mg.