Management of ACS

Question 1

What is the initial drug theray for all patients presenting with ACS?

Answer 1

aspirin 300mg
oxygen
morphine
nitrates

Question 2

What dose of aspirin should be given?

Answer 2

300mg

Question 3

When would you consider giving oxygen?

Answer 3

Oxygen saturations < 94%

Question 4

When would you give morphine for ACS?

Answer 4

Only if the patient is in severe pain

Question 5

When would you use nitrates with caution?

Answer 5

Patient is hypotensive

Question 6

How can nitrates be administered?

Answer 6

Sublingually or intravenously

Question 7

What is the main STEMI criertia for diagnosis?

Answer 7

Symptoms consistent with ACS (generally of ≥ 20 minutes) with persistent (> 20 minutes) ECG features in ≥ 2 contiguous leads

Question 8

What ECG changes would be diagnostic for a STEMI in men under 40?

Answer 8

2.5 mm (i.e ≥ 2.5 small squares) ST elevation in leads V2-3

Question 9

What ECG changes would be diagnostic for a STEMI in men over 40?

Answer 9

≥ 2.0 mm (i.e ≥ 2 small squares) ST elevation in leads V2-3

Question 10

What ECG changes would be diagnostic for a STEMI in women?

Answer 10

1.5 mm ST elevation in V2-3 in women

Question 11

What other ECG changes would indicate a STEMI?

Answer 11

1 mm ST elevation in other leads
new LBBB

Question 12

Once a STEMI has been diagnosed, what are the 2 types of coronary reperfusion therapy?

Answer 12

Percutaneous coronary intervention
Fibrinolysis

Question 13

When would PCI be carried out?

Answer 13

Present within 12 hours of the onset of symptoms
AND
PCI can be delivered within 120 minutes of the time when fibrinolysis could have been given

Question 14

What would you consider if there is a significant delay in being able to provide PCI?

Answer 14

Fibrinolysis

Question 15

When should fibrinolysis be offered?

Answer 15

Within 12 hours of the onset of symptoms if primary PCI cannot be delivered within 120 minutes

Question 16

How is PCI carried out?

Answer 16

Radial access

Question 17

What needs to be taken prior to PCI?

Answer 17

‘dual antiplatelet therapy’,

Question 18

What is dual antiplatelet therapy?

Answer 18

Aspirin and
not taking an oral anticoagulant: prasugrel
if taking an oral anticoagulant: clopidogrel

Question 19

If patient is not taking an oral anticoagulant, what would you give with aspirin for dual antiplatelt therapy?

Answer 19

Prasugrel

Question 20

If patient is taking an oral anticoagulant, what would you give with aspirin for dual antiplatelt therapy?

Answer 20

Clopidogrel

Question 21

What is the main drug therapy used for PCI?

Answer 21

Unfractionated heparin with bailout glycoprotein IIb/IIIa inhibitor (GPI)

Question 22

When should an ECG be carried out after fibrinolysis?

Answer 22

60-90 minutes

Question 23

What can be done after fibrinolysis if the patient has persistent myocardial ischaemia?

Answer 23

PCI should be considered.