ACS and STEMI

Question 1

Acute coronary syndrome

Answer 1

Any condition where blood supplied to heart muscle reduced

Question 2

What is an NSTEMI

Answer 2

Non ST elevation myocardial infarction

Question 3

What is a STEMI

Answer 3

ST elevation myocardial infarction

Question 4

Are STEMIs or NSTEMIs more prevalent

Answer 4

NSTEMIs

Question 5

2 types of NSTEAC

Answer 5

NSTEMI
unstable angina

Question 6

How to tell between NSTEMI and unstable angina

Answer 6

troponin positive in NSTEMI
Troponin negative in unstable angina

Question 7

STEMI characteristics

Answer 7

Persistent Acute chest pain 20min+
ST segment elevation

Question 8

What usually causes a STEMI

Answer 8

Acute total coronary occlusion

Question 9

NSTEMI ECG characteristics

Answer 9

No persistent ST elevation
Persistent or transient ST depression
Persistent or transient T wave inversion

Question 10

Is troponin elevated in STEMI

Answer 10

Yes

Question 11

When should ECG be taken in suspected ACS

Answer 11

First - before history and examination

Question 12

What should be done if initial ECG normal in suspected ACS

Answer 12

Repeat/serial ECGs

Question 13

What are the 3 criteria needed for acute myocardial infarction

Answer 13

Acute myocardial injury - elevated troponin
Rise/fall of cTn values w at least 1 value above 99th percentile
Clinical evidence of acute myocardial ischaemia with at least 1 of - myocardial ischaemia symptoms, new ischaemic ECG changes, pathological Q waves, new loss of viable myocardium or new regional wall motion abnormality in pattern consistent w ischaemic aetiology, coronary thrombus

Question 14

3 types of ACS

Answer 14

STEMI
NSTEMI
Unstable angina

Question 15

ACS signs and symptoms

Answer 15

Chest pain >15 mins
Pain in other areas
Nausea
Vomiting
Sweating
Breathlessness
Haemodynamic instability
Abrupt deterioration in stable angina

Question 16

ACS risk factors

Answer 16

Hypertension
Smoking
High lipid signs

Question 17

What are xanthelasma and arcus lipids signs of

Answer 17

High lipids

Question 18

How can acute chest pain be investigated

Answer 18

Blood test
Chest x ray
Resting ECG
Coronary CT
Stress echo
Stress MRI
Myocardial perfusion scan
Coronary angiogram

Question 19

what does ABCDE stand for in ACS management

Answer 19

Airways and oxygen
Breathing and ventilation
Circulation and shock management
Disability due to neurological deterioration
Exposure and examination

Question 20

What ACS treatment is needed while waiting for transfer

Answer 20

Anti platelet therapy
Analgesia

Question 21

Anti platelet therapies

Answer 21

Aspirin
Clopidogrel
Ticagrelor
Prasugrel

Question 22

Which Analgesics for ACS while waiting for transfer

Answer 22

Glyceryl trinatrate - GTN
Opioids

Question 23

Limitations of clopidogrel

Answer 23

Slow onset of action
Variable degree platelet inhibition
Variable clinical response
Drug interaction

Question 24

How often are clopidogrel, prasugrel, and ticagrelor administered

Answer 24

Clopidogrel - once daily
Prasugrel - once daily
Ticagrelor - twice daily

Question 25

How long does clopigrel, Prasugrel, and Ticagrelor have an effect for

Answer 25

C - 3-10 days P - 7-10 days T - 3-5 days

Question 26

What is the minimum amount of time clopidogrel, Prasugrel, and ticagrelor should be discontinued before surgery

Answer 26

C - 5 days P - 7 days T - 3 days

Question 27

When should oxygen be given to ACS patients

Answer 27

SaO2<90% or PaO2<60mmHg

Question 28

When are Q waves pathological

Answer 28

>2mm deep or wide

Question 29

What is used for rate control in ACS

Answer 29

Short acting beta blockers

Question 30

What factors are involved in calculating grace score

Answer 30

Age Heart rate Systolic blood pressure Creatinine Congestive heart failure Cardiac arrest at admission ST segment deviation Elevated cardiac enzymes/markers

Question 31

When should an immediate coronary angiography be offered

Answer 31

People with unstable angina or NSTEMI where clinical condition is unstable

Question 32

Wellens syndrome

Answer 32

abnormal electrocardiographic (ECG) pattern, deeply inverted T waves in leads V2 and V3, that are secondary to proximal LAD stenosis

Question 33

When should an urgent call be made to cardiology for immediate Cather termination consideration

Answer 33

Inability to eliminate chest pain using maximal medical therapy Wellness syndrome Dynamic ST Depression