RRAPID: Acute Coronary Syndrome

Question 1

Risk Factors?

Answer 1

Increasing age
Male 
FH of IHD
Smoking
HTN
DM
Hyperlipidaemia
Obesity 
Sedentary lifestyle

Question 2

Features? (7)

Answer 2

Chest pain (tight, heavy, crushing, radiating to the jaw or left arm)
Hx of angina
SOB
Sweaty
Nausea
Palpitations
Signs of HF (dyspnoea, raised JVP, crackles at lung bases) - CXR

Question 3

What happens to troponin in STEMI & NSTEMI?

Answer 3

Rises (after 12 hours) –> taken on admission and 4 hrly

Question 4

ECG changes in STEMI? (2)

Answer 4

Early: T-wave inversion and ST depression
Time of MI: ST elevation (>2 mm in 2+ chest leads) or (>1 mm in 2+ limb leads)
Late: Q-wave presence

OR

New left bundle branch block (WiLLiaM) - W (V1), M (V6)

Question 5

ECG changes in NSTEMI or unstable angina? (2)

Answer 5

ST depression (> 0.5 mm)

OR

T wave inversion/Q wave presence

Question 6

Response to NSTEMI? (ABCDE)

Answer 6

ABCDE
O2 via reservoir mask 
Chest X-ray (HF)
IV access & bloods: FBC, U&E's, glucose, calcium, magnesium, glucose, serial troponin
Blood cultures (if sepsis suspected) 
Serial ECG's

Question 7

Medication Mx for NSTEMI?

Answer 7

(MONA FC)
Analgesia: morphine 2.5 - 10 mg IV bolus (slow)

Glyceryl trinitrate (GTN) (2 sprays or 500 mcg tablet) sublingual or buccal

Aspirin 300 mg PO

Clopidegrel 300 mg PO

Cyclizine (50 mg) - anti-emetic PRN

Refer to cardiologist

Question 8

After referral to cardiologist what can be further given for NSTEMI?

Answer 8

Fondaparinux 2.5 mg SC

Question 9

Response to STEMI (ABCDE)?

Answer 9

ABCDE
O2 via reservoir mask 
Chest X-ray (HF)
IV access & bloods: FBC, U&E's, glucose, calcium, magnesium, glucose, serial troponin
Blood cultures (if sepsis suspected) 
Serial ECG's

Question 10

Medication Mx for STEMI?

Answer 10

MONA:

Analgesia: morphine 2.5 - 10 mg IV bolus (slow)

Glyceryl trinitrate (GTN) (2 sprays or 500 mcg tablet) sublingual or buccal

Aspirin 300 mg PO

Question 11

After referral to cardiologist what can be further given STEMI?

Answer 11

Clopidogrel 300 mg PO

Question 12

Rx of choice if on-going ischaemia & within 12 hours?

Answer 12

PCI (percutaneous coronary intervention)

Question 13

Alternative if PCI not available?

Answer 13

Thrombolysis

Question 14

Makes sure to do serial ECG’s, why?

Answer 14

First one may be aysmptomatic

Question 15

Common early complications that can be fatal?

Common late complications?

Answer 15

Arrhythmias (AF, SVT)

HF, Embolism, Pericarditis (Dressler’s syndrome)

Question 16

What standard medication are they discharge on?

Answer 16

Beta-blockers --> not with Ca blocker or Thiazide diuretic
Aspirin
Statin
ACE I e.g. Ramipril 
GTN