Acute Coronary Syndrome Flashcards

1
Q

3 factors affecting prognosis of ACS?

A

Age, LV function, ST changes

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2
Q

How many hours does it take for troponin to rise?

A

3

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3
Q

When do troponin levels peak?

A

24-48 hours

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4
Q

First drug and dose when ACS suspected?

A

aspirin 300mg

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5
Q

When not to give sublingual glyceryl trinitrate in NSTEMI?

A

SBP <90 mmHg

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6
Q

When do you give O2 in ACS?

A

if SaO2 <94%

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7
Q

What analgesic, dose and route of administration do you use in MI?

A

Morpine, 5-10 mg, IV

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8
Q

What antiemetic do you give in MI?

A

Metoclopramide 10 mg IV

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9
Q

What is the second anti-platelet given before PCI in STEMI? (x2)

A

Ticagrelor or Clopidogrel 300 mg loading dose

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10
Q

What dose and for how long do you continue Clopidogrel post STEMI?

A

75mg/day for 30 days

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11
Q

When do you choose fibrinolysis over PCI in STEMI?

A

If PCI not available within 120 mins.

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12
Q

What antithrombin treatment do you give to NSTEMI if NO angiography in next 24 hours?

A

Fondaparinux

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13
Q

If angiography for NSTEMI in next 24 hours what anticoagulant do you give?

A

Heparin

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14
Q

What do you give as second anti-platelet drug in NSTEMI?

A

Clopidogrel 300mg

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15
Q

How long do you continue clopidogrel for post-NSTEMI?

A

12 months

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16
Q

What glycoprotein IIb/IIIa receptor antagonist should patients consider after NSTEMI is intermediate/high risk of CV event or scheduled angiography in next 96 hours?

A

epitfibatide or tirofiban

17
Q

Warfarin for three months following what MI?

A

Large anterior MI

18
Q

Drugs started post ACS?

A

1) Aspirin
2) beta-blocker
3) ACEi
4) Statin

19
Q

how long off driving after successful angioplasty?

A

1 week

20
Q

Aspirin MOA?

A

Inhibits production of thromboxane A2 (antiplatlet)

21
Q

What antiplatelet has following MOA:

Inhibits ADP binding to its platelet receptor

A

Clopidogrel

22
Q

Fondaparinux MOA?

A

Activated antithromin III - which potentiates inhibition of coagulation factor Xa

23
Q

What drug has following MOA?

reversible direct thrombin inhibitor

A

Bivalirudin

24
Q

Eptifibatide, abciximab, tirofiban MOA?

A

Glycoprotein IIb/IIIa receptor antagonist

25
Q

Poor prognostic factors for ACS?

A

1) age >65
2) History of HF
3) peripheral vascular disease
4) Reduced SBP
5) Killip Class
6) creatinine conc.
7) elevated cardia biomarkers
8) cardiac arrest on admission
9) ST segment deviation

26
Q

What system estimates 6 month mortality in ACS?

A

GRACE score - decides treatment for NSTEMI, angiography, Eptifibatide/tirofiban use

27
Q

Killip class I?

A

No clinical signs of heart failure

28
Q

Killip class II?

A

Lung crackles, S3

29
Q

What Killip class if patient has frank pulmonary oedema?

A

Class III

30
Q

What emergency if categorised as killip class IV?

A

Cardiogenic shock

31
Q

Killip Class IV?

A

Frank pulmonary oedema, SBP <90 mmHg (Cardiogenic shock)