ACS Flashcards
(35 cards)
What are the clinical symptoms consistent with ACS for a STEMI diagnosis?
Symptoms generally of ≥ 20 minutes duration with persistent ECG features in ≥ 2 contiguous leads.
What ST elevation measurements are required for men under 40 years in leads V2-3?
≥ 2.5 mm ST elevation.
What ST elevation measurements are required for men over 40 years in leads V2-3?
≥ 2.0 mm ST elevation.
What ST elevation measurement is required in leads V2-3 for women?
1.5 mm ST elevation.
What is the required ST elevation measurement in other leads for STEMI?
1 mm ST elevation.
When should new LBBB be considered in the context of STEMI?
New LBBB should be considered new unless there is evidence otherwise.
What is the first step after confirming a STEMI?
Immediately assess eligibility for coronary reperfusion therapy.
What are the two types of coronary reperfusion therapy?
- Percutaneous coronary intervention (PCI)
- Fibrinolysis
When should PCI be offered?
If presentation is within 12 hours of symptom onset AND PCI can be delivered within 120 minutes of the time when fibrinolysis could have been given.
What should be considered if patients present after 12 hours with ongoing ischaemia?
PCI should still be considered.
What type of stents are now primarily used in PCI?
Drug-eluting stents.
What access route is preferred for PCI?
Radial access.
When should fibrinolysis be offered?
Within 12 hours of symptom onset if primary PCI cannot be delivered within 120 minutes.
What is a practical example for fibrinolysis administration?
A patient presenting with STEMI to a small DGH without PCI facilities who cannot be transferred within 120 minutes.
What is dual antiplatelet therapy?
Aspirin + another drug.
What should be given if the patient is not taking an oral anticoagulant prior to PCI?
Prasugrel.
What should be given if the patient is taking an oral anticoagulant prior to PCI?
Clopidogrel.
What is the recommended drug therapy during PCI with radial access?
Unfractionated heparin with bailout glycoprotein IIb/IIIa inhibitor.
What is the recommended drug therapy during PCI with femoral access?
Bivalirudin with bailout glycoprotein IIb/IIIa inhibitor.
When should fondaparinux be offered?
To patients not at high risk of bleeding and not having immediate angiography.
What should be given if immediate angiography is planned or creatinine is > 265 µmol/L?
Unfractionated heparin.
What is the most widely used tool for risk assessment in acute coronary events?
Global Registry of Acute Coronary Events (GRACE).
What factors are considered in the GRACE score?
- Age
- Heart rate
- Blood pressure
- Cardiac (Killip class)
- Renal function (serum creatinine)
- Cardiac arrest on presentation
- ECG findings
- Troponin levels
When should immediate coronary angiography be performed for NSTEMI/unstable angina?
For clinically unstable patients.
