ACS

Question 1

diagnosis of STEMI

Answer 1

ST elevation >2mm adjacent chest leads
ST elevation >1mm in adjacent limb leads

new LBBB

Question 2

diagnosis of NSTEMI

Answer 2

2/3 of:
cardiac chest pain
newly abnormal ECG (not ST elevation)
raised troponin

Question 3

ST elevation - II, III, aVF

Answer 3

inferior

RCA

Question 4

ST elevation - V1, V2

Answer 4

septal

proximal LAD

Question 5

ST elevation - V3, V4

Answer 5

anterior

LAD

Question 6

ST elevation - V5, V6

Answer 6

apex

distal LAD/LCx/RCA

Question 7

ST elevation - I, aVL

Answer 7

lateral

LCx

Question 8

ST elevation - V7-V9

Answer 8

posterolateral

RCA/LCx

Question 9

interpretation of troponin - low

Answer 9

definitely no myocardial cell death

Question 10

interpretation of troponin - mildly raised

Answer 10

equivocal result, need repeated 6-12hrs

if repeat is raised on repeat = MI

if repeat is stable or falling = MI unlikely

Question 11

interpretation of troponin - definitely raised

Answer 11

MI confirmed

Question 12

STEMI Mx

Answer 12

Oxygen 
loading dose aspirin 300mg
loading dose 2nd anti-platelet
sublingual GTN 
IV morphine

PCI if within 2hrs

Question 13

NSTEMI Mx

Answer 13

oxygen
loading dose aspirin 300mg + fondaparinux
sublingual GTN
IV morphine

Question 14

Post-MI Mx

Answer 14

aspirin 75mg
2nd anti-platelet
beta blocker
ACEI 
high dose statin

Question 15

ventricular free wall rupture

Answer 15

necrosis of walls can lead to rupture, allowing blood into pericaridal space

leads to rapid tamponade

Question 16

Dressler’s syndrome

Answer 16

persistent fever and pleuritic chest pain 2-3wks post MI

Mx = high dose aspirin