Myocardial Ischaemia Part 2

Question 1

What group of patients should you prescribe Nitrates in caution and why

Answer 1

Elderly
- due to risk of falls

Question 2

Side effects of Nitrates

Answer 2

• dizziness
• flushing
• headache

Question 3

What is the initial management of all Acute Coronary syndromes (STEMI, NSTEMI, Unstable Angina)

Answer 3

• Aspirin 300mg loading dose
• pain relief (GTN or IV Morphine)
• Oxygen

Question 4

What are the 3 stages of Acute Coronary syndromes

Answer 4

1: Unstable Angina
(partial blockage of artery)

2: NSTEMI
(partial blockage of artery + myocardial necrosis)

3: STEMI
(complete blockage of artery + myocardial necrosis)

Question 5

All cases of STEMI require what surgery

Answer 5

Percutaneous Coronary Intervention (PCI) within 2 hours

(unblocking blood vessels)

Question 6

What is the Secondary mangement of all Acute Coronary Syndromes (STEMI, NSTEMI, Unstable Angina)

Answer 6

Dual Antiplatelet Therapy + ACEi/ARB + BB + Statin (MAX)

Question 7

What does Dual antiplatelet therapy consist of

Answer 7

Aspirin (for life)
+
Clopidogrel / Prasugrel / Ticagrelor
(for 12 months)

Question 8

If a patient needs dual antiplatelet therapy to reduce the risk of thrombosis, but the patient is already on anticoagulants what can be done to manage bleeding risk

Answer 8

• use clopidogrel with aspirin instead of others
• shorten the dual anti platelet course