ACS

Question 1

What is the 12 lead ECG used for?

Answer 1

Helps to classify type of ACS

Question 2

What are the 3 types of ACS?

Answer 2

STEMI
NSTEMI
Unstable angina

Question 3

What are troponin enzymes released by?

Answer 3

Myocardial cells when the heart muscle is damaged. They are released into the blood

Question 4

Severity of chest pain indicates type of ACS. True or false?

Answer 4

False

Question 5

What is given in initial symptom relief of MI?

Answer 5

Morphine IV
Oxygen 
Aspirin
Nitrate 
(+IV antiemetic)

Question 6

If patient has STEMI, PCI is needed. True or false?

Answer 6

True

Question 7

What is used to assess the risk in NSTEMI and unstable angina for 6 month mortality?

Answer 7

GRACE score

Question 8

What is the GRACE score used for?

Answer 8

To establish risk to see if PCI is needed in NSTEMI and unstable angina

Question 9

After placing a stent in the artery, patient may have a sudden death. Why?

Answer 9

As they are prone to cardiac tachycarida due to reperfusion

Question 10

What is the reperfusion treatment PCI for STEMI?

Answer 10

Before PCI, patient is given short-term antiplatelets (combination of aspirin and clopidogrel)
During procedure - GPIIb/IIIa IV.
After procedure - long-term anti-platelet

Question 11

Ticagrelor is more effective than clopidogrel at reducing CV death, MI etc. so why is clopidogrel used more?

Answer 11

Because ticagrelor can cause more serious bleeding episodes especially intercranial bleeds

Question 12

Why are GPIIb/IIIa inhibitors given by continuous IV?

Answer 12

Because they have short half-lives

Question 13

Thrombolysis reperfusion is used for patients following PCI. True or false?

Answer 13

False - only used for patients who cannot have PCI

Question 14

Streptokinase can be used as a fibrinolytic if PCI cannot be done, but if patient has previously taken streptokinase, they cannot take it again. Why?

Answer 14

Because there is a risk of antibodies causing loss of effect or anaphylaxis as streptokinase is a bacterial protein

Question 15

Stroke within the last 4 weeks is a contraindication for use of fibrinolytics. True or false?

Answer 15

True

Question 16

Antithrombin therapy in STEMI is given at point of admission to hospital. Why?

Answer 16

To protect against re-occlusion

e.g. LMW heparin or fondaparinux

Question 17

What is the medical treatment for NSTEMI?

Answer 17

Regardless of GRACE score, patients are given aspirin and anti-thrombin therapy
Depending on GRACE score, they’re given clopidogrel (300mg if 1.5-3% and 300-600mg if 3-9%)

Question 18

What is CABG?

Answer 18

Surgical revascularisation used rather than PCI in people with multi-vessel disease who have diabetes or are over 65

Question 19

If patient has a high GRACE score, they should be treated aggressively with medication and assessed for PCI within 96 hours of admission. What if they are low risk?

Answer 19

Medically manage