Acute Coronary Syndrome

Question 1

Recite the ACS CPG

Answer 1

Question 3

What three assessments should be performed initially?

Answer 3

• Signs and symptoms
• 12-lead ECG (within 10 minutes)
• Check if Rx already given (e.g., aspirin, GTN).

Question 4

When should you request early MICA/aeromedical support?

Answer 4

If STEMI is suspected.

Question 5

What should you do early for STEMI?

Answer 5

Provide early hospital notification.

Question 6

What antiplatelet medication should be given?

Answer 6

Aspirin 300 mg oral, if not already administered.

Question 7

When should you give GTN 600 mcg S/L?

Answer 7

If SBP > 100 mmHg.

Question 8

When should you give GTN 300 mcg S/L?

Answer 8

If no previous GTN, or patient is small (≤ 60 kg), elderly, borderline BP or frail.

Question 9

How often can GTN be repeated, and at what dose?

Answer 9

Repeat 300 or 600 mcg S/L every 5 minutes, titrated to pain or side effects.

Question 10

What form of GTN can be used topically, and where is it applied?

Answer 10

GTN patch 50 mg (0.4 mg/hr) to upper torso/arms.

Question 11

What should you do if BP falls below 100 mmHg with a GTN patch?

Answer 11

Remove the patch.

Question 12

What do you do if pain persists or nitrates are contraindicated?

Answer 12

Treat with opioids as per CPG A0501 Pain Relief.

Question 13

Define the BP threshold for isolated hypertension.

Answer 13

SBP > 160 mmHg or DBP > 100 mmHg.

Question 14

How is isolated hypertension managed?

Answer 14

MICA can administer GTN 300 mcg S/L, repeat every 5 minutes if needed.

Question 15

How is STEMI managed if symptom onset is <12 hours?

Answer 15

Continue Rx as per CPG A0408 STEMI Management.

Question 16

What do you do for STEMI with symptom onset >12 hours?

Answer 16

Transmit 12-lead ECG and provide hospital notification.

Question 17

What extra notification is required for STEMI requiring transfer?

Answer 17

Notify ARV via clinician if secondary transfer may be required.

Question 18

How is NSTEACS/unstable angina managed?

Answer 18

Transport to an appropriate facility.

Question 19

What is the definition and pathophysiology for ACS

Answer 19

🩺 Definition: Acute Coronary Syndrome (ACS)

Acute Coronary Syndrome is an umbrella term used to describe a range of conditions caused by sudden, reduced blood flow to the heart. It includes:

Unstable angina
Non-ST elevation myocardial infarction (NSTEMI)
ST elevation myocardial infarction (STEMI)
These conditions are caused by partial or complete blockage of a coronary artery, which can result in damage or death of heart muscle tissue.

🚨 Note:
STEMI = complete blockage → full-thickness muscle damage
NSTEMI = partial blockage → partial-thickness damage
Unstable angina = ischaemia without detectable infarction (troponin normal)