Acute Coronary Syndrome

Question 1

what is ACS

Answer 1

reduction/ occlusion of the blood supply to the heart causing ischaemia
due to atherosclerotic plaques
includes unstable angina, STEMI and NSTEMI

Question 2

how can ACS present

Answer 2

central crushing chest pain
diaphoresis
N+V
feelign of impending doom

Question 3

what is the difference in the release of troponins and Creatine kinase

Answer 3

troponin: rise rapidly and peaks around 48 hours after chest pain

creatinine kinase: raises rapidly but at a lower volume and drops off alot faster

Question 4

what changes over time do you see in an ECG for a STEMI

Answer 4

up to 12 hours: peaked T waves into ST elevation
12-24 hours: pathological P waves, ST elevation, +/- inverted T waves
up to a week: pathological Q waves, T wave inversion
Q waves can persist for up to a month

Question 5

what is the initial medical management for ACS

Answer 5

M - morphine
O - oxygen
A - aspirin and clopidogrel
N - nitrates

Question 6

what is first line definitive management for a STEMI

Answer 6

primary percutaneous intervention
if within 2 hrs of when fibrinolysis could’ve been given and within 12 hours of onset of symptoms

Question 7

what are long term medications which should be given after STEMI

Answer 7

B - Beta Blocker
A - Anticoagulant (aspirin/clopidogrel)
S - statin
I - inhibitor of angiotensin 2 (ACEi/ARB)
C - correction of risk factors

Question 8

how is definitive management of unstable angina or NSTEMI decided

Answer 8

low risk: monitoring of ECG, markers and risk
high risk:
A - aspirin
A - anti-coagulant (clopidogrel)
B - Beta Blocker
C - consider revascularization (angioplasty)

Question 9

what are some early complications post ACS which can occur in the first week

Answer 9

arrythmia
myocardial rupture
papillary muscle rupture
Acute HF
pericarditis
PE

Question 10

what are some late complications that can arise post ACS

Answer 10

Dressler’s syndrome
CHF