Acute Coronary Syndrome

Question 1

Risks that increase ACS

Answer 1

Coronary heart disease
Smoking
Increased fat diet
Diabetes
High cholesterol
High BP
Obese/Overweight

Question 2

Unstable angina vs STEMI vs NSTEMI. What procedure is needed promptly for which type

Answer 2

STEMI needs PCI within 2 hrs

Question 3

What is the difference between STEMI and NSTEMI or Unstable angina

Answer 3

STEMI complete and prolonged blockage of coronary artery
ST elevated

NSTEMI/UA severe narrowing of artery
No ST elevation

Question 4

What is difference between unstable angina and NSTEMI or STEMI

Answer 4

NSTEMI/STEMI elecation of cardiac biomarkers troponin

UA no elevation of cardiac biomarkers

Question 5

What is initial management of ACS

Answer 5

Loading dose asprin 300mg
Painrelief GTN

With or without IV morphine

Oxygen if <94%

Monitor for hyperglycaemia then offer insulin

Fondaparinux for NSTEMI/UA if no high bleeding risk
Unfractionated heparin if high bleeding risk

Question 6

What is initial management of STEMI

Answer 6

PCI within 2 hrs of fibronolysis

Heparin if having OCI through radial access

Prasugrel as second antiplatelet if not already taking oral anticoagulant

Clopidogrel as second antiplatelet if already on oral anticoagulant

Question 7

Secondary prevention plan of ACS

Answer 7

ACEi or ARB if C/I

DAPT - lifelong aspirin
12 months clopi, prasu, tica

Beta blocker - lifelong if reduced LVEF
12 months if not

Statin - high dose

PPI - lansop if clopi

Question 8

When can PCI be used other than STEMI

Answer 8

In NSTEMI as prophylaxis of future MI