ACS

Question 1

What is acute coronary syndrome

Answer 1

A range of conditions which are associated with sudden, reduced blood flow to the heart.

Question 2

ACS Symptoms

Answer 2

• chest pain (angina) aching/pressure/tightness
• radiating pain into shoulders, arms, upper abdo, back, neck and jaw
• nausea and vomiting
• indigestion
• dyspnoea
• dizziness/lightheaded/ fainting
• unusual fatigue
• anxiety

Question 3

ACS common cause

Answer 3

Build up of fatty plaques on walls of coronary arteries.

Leading to thromboli and emboli

Clots form restricting blood flow to heart = ischaemic cells = cell death = all that bad stuff

Question 4

Myocardial flow chart

Answer 4

Myocardial ischaemia
Myocardial injury
Myocardial infarction

Question 5

Ddx for chest pain?

Answer 5

• ACS
• stable angina
• unstable angina
• AMI

Question 6

Role of ECGs in ACS

Answer 6

Myocardial ischaemia alters electrical conduction of current across myocardium

• ECGs can detect change by not all the time

Question 7

PQRST for pain assessment

Answer 7

Provokes

• what causes it
• makes it better/worse

Quality

• feel like?
• sharp,dull,stabbing,burning, crushing.

Radiates

• does it move/stays in one place?
• start anywhere else and now localised

Severity
- 0/10

Time

• when did it start
• how long has it been?

Question 8

Patient management for ACS

Answer 8

• Aspirin
• Nitrates
• oxygen
• morphine
• ondansertron

Question 9

Aspirin

Action
Contraindication

Answer 9

Non steroidal anti inflammatory drug

• inhibits platelet aggregation, limiting thromboli enlargement
• reduces prostaglandin production relieveing pain and fever

Contraindications of

• patients with bleeding tendency
• allergy
• trauma patients

Question 10

Nitrates gtn

Answer 10

Vasodilator
Dismayed coronary arteries and systemic veins/arteries

Therefore decreasing preload

Contraindications of 
- low systolic bp <90
- pulse rate <50 >150
- use of erectile dysfunction drugs 
Most 24hrs
Cialis/Tadalafil = 96 hours

Question 11

Morphine

Answer 11

Opioid analgesic

• Decreases pain perception and anxiety
• Causes peripheral vasodilation

Therefore helpful in ACS

Contraindications Altered level of consciousness

10mg in 1ml + 9ml saline

2.5-5mg iv
every 5min.
Max 0.5mg/kg
Rep procedure every 30min

Question 12

Ondansertron

Answer 12

Anti emetic and anti nauseant

Blocks central and peripheral 5-HT3 receptors

Question 13

Thrombolysis

Answer 13

Tissue plasminogen activator (tPA) releases from endothelial cells activates plasminogen

Plasminogen > streptokinase > plasmin

Plasmin breaks down fibrin into soluble fragments

I’m