acs

Question 1

What is a poor prognostic factor related to age?

Answer 1

Age

Older age is often associated with worse outcomes in various medical conditions.

Question 2

What condition’s history is a poor prognostic factor?

Answer 2

Development (or history) of heart failure

Prior heart failure can indicate a higher risk for adverse outcomes.

Question 3

What vascular condition is considered a poor prognostic factor?

Answer 3

Peripheral vascular disease

This condition can compromise blood flow and worsen overall health.

Question 4

What blood pressure level is a poor prognostic factor?

Answer 4

Reduced systolic blood pressure

Low systolic blood pressure may indicate poor cardiac function.

Question 5

What classification system includes a poor prognostic factor?

Answer 5

Killip class*

Killip class is used to assess heart failure severity and prognosis.

Question 6

What initial lab value is a poor prognostic factor?

Answer 6

Initial serum creatinine concentration

Elevated creatinine levels suggest impaired kidney function and worse prognosis.

Question 7

What cardiac condition on admission is a poor prognostic factor?

Answer 7

Cardiac arrest on admission

Patients who arrive in cardiac arrest have a significantly worse prognosis.

Question 8

What cardiac marker level is considered a poor prognostic factor?

Answer 8

Elevated initial cardiac markers

High levels of cardiac markers indicate myocardial injury and poor outcomes.

Question 9

What ECG finding is a poor prognostic factor?

Answer 9

ST segment deviation

ST segment changes can indicate ischemia or other cardiac issues, affecting prognosis.

Question 11

What should all patients with ST-elevation myocardial infarction (STEMI) receive in the absence of contraindications?

Answer 11

Aspirin and a P2Y12-receptor antagonist

P2Y12-receptor antagonists include clopidogrel, ticagrelor, and prasugrel.

Question 12

Which P2Y12-receptor antagonist is often favored over clopidogrel due to improved outcomes?

Answer 12

Ticagrelor

Ticagrelor has slightly higher rates of bleeding compared to clopidogrel.

Question 13

What does SIGN’s 2016 guidelines recommend regarding prasugrel?

Answer 13

Consider prasugrel if the patient is going to have a percutaneous coronary intervention

Prasugrel is another P2Y12-receptor antagonist.

Question 14

What anticoagulant is usually given to patients undergoing PCI?

Answer 14

Unfractionated heparin

Alternatives include low-molecular weight heparin.

Question 15

According to NICE, when should supplemental oxygen be offered to patients?

Answer 15

To people with SpO2 less than 94% who are not at risk of hypercapnic respiratory failure and to those with COPD at risk of hypercapnic respiratory failure

Aiming for SpO2 of 94-98% for the former and 88-92% for the latter.

Question 16

What is the gold-standard treatment for STEMI?

Answer 16

Primary percutaneous coronary intervention (PCI)

Thrombolysis should be performed if primary PCI is not available.

Question 17

Which thrombolytic agent has shown clear mortality benefits over streptokinase?

Answer 17

Tissue plasminogen activator (tPA)

tPA is preferred for its efficacy in mortality reduction.

Question 18

What is a notable advantage of tenecteplase compared to alteplase?

Answer 18

Easier to administer and has non-inferior efficacy

Tenecteplase has a similar adverse effect profile to alteplase.

Question 19

How long after thrombolysis should an ECG be performed to assess ST elevation resolution?

Answer 19

90 minutes

An ECG is used to determine if there has been greater than 50% resolution.

Question 20

What is the recommended action if there is not adequate ST elevation resolution after thrombolysis?

Answer 20

Rescue PCI is superior to repeat thrombolysis

Rescue PCI should be performed if thrombolysis is inadequate.

Question 21

What does NICE recommend for glycaemic control in patients with diabetes mellitus during acute coronary syndromes?

Answer 21

Use a dose-adjusted insulin infusion with regular blood glucose monitoring

Blood glucose levels should be kept below 11.0 mmol/l.

Question 22

Are intensive insulin therapy regimes recommended routinely for managing hyperglycaemia in acute coronary syndromes?

Answer 22

No, they are not recommended routinely

DIGAMI regimes (intravenous insulin and glucose infusion) are not routinely suggested.

Question 23

What are examples of adenosine diphosphate (ADP) receptor inhibitors?

Answer 23

• Clopidogrel
• Prasugrel
• Ticagrelor
• Ticlopidine

These medications are used to prevent platelet aggregation.

Question 24

What is the main target of ADP receptor inhibition?

Answer 24

The P2Y12 receptor

P2Y12 receptor is crucial for sustained platelet aggregation and stabilization of the platelet plaque.

Question 25

What are the G-coupled receptors involved in platelet activation by ADP?

Answer 25

* P2Y1 * P2Y12 ## Footnote These receptors mediate the effects of adenosine diphosphate on platelets.

Question 26

What is the significance of using aspirin in conjunction with ADP inhibitors?

Answer 26

They block different platelet aggregation pathways ## Footnote This potential synergy has been explored in clinical trials, especially for high-risk patients.

Question 27

Which ADP inhibitor was previously the most commonly used?

Answer 27

Clopidogrel ## Footnote Its interindividual variability in antiplatelet effects led to the development of newer agents.

Question 28

What notable reduction was observed in trials comparing prasugrel and aspirin to clopidogrel and aspirin?

Answer 28

Marked reduction in short- and long-term ischaemic events ## Footnote This was particularly noted in moderate- to high-risk ACS patients.

Question 29

What does the current NICE guideline recommend for dual antiplatelet treatment (DAPT) in ACS?

Answer 29

Aspirin (75mg daily) and Ticagrelor (90mg twice daily) for 12 months ## Footnote This is recommended as a secondary prevention strategy.

Question 30

What is the recommended aspirin dosage for patients with ACS undergoing PCI?

Answer 30

Aspirin (75-100mg daily) ## Footnote It should be combined with either prasugrel, ticagrelor, or clopidogrel for 12 months.

Question 31

What is a notable adverse effect of ticagrelor?

Answer 31

Dyspnoea ## Footnote This may occur due to impaired clearance of adenosine.

Question 32

Which proton pump inhibitors interact with clopidogrel?

Answer 32

* Omeprazole * Esomeprazole ## Footnote These interactions can reduce the antiplatelet effects of clopidogrel.

Question 33

What are absolute contraindications for prasugrel use?

Answer 33

* Prior stroke or transient ischaemic attack * High risk of bleeding * Prasugrel hypersensitivity ## Footnote These conditions increase the risk of adverse events.

Question 34

In which patients is ticagrelor contraindicated?

Answer 34

* High risk of bleeding * History of intracranial haemorrhage * Severe hepatic dysfunction ## Footnote Caution is also advised in patients with acute asthma or COPD.