Acute Coronary Syndrome

Question 1

3 factors affecting prognosis of ACS?

Answer 1

Age, LV function, ST changes

Question 2

How many hours does it take for troponin to rise?

Answer 2

3

Question 3

When do troponin levels peak?

Answer 3

24-48 hours

Question 4

First drug and dose when ACS suspected?

Answer 4

aspirin 300mg

Question 5

When not to give sublingual glyceryl trinitrate in NSTEMI?

Answer 5

SBP <90 mmHg

Question 6

When do you give O2 in ACS?

Answer 6

if SaO2 <94%

Question 7

What analgesic, dose and route of administration do you use in MI?

Answer 7

Morpine, 5-10 mg, IV

Question 8

What antiemetic do you give in MI?

Answer 8

Metoclopramide 10 mg IV

Question 9

What is the second anti-platelet given before PCI in STEMI? (x2)

Answer 9

Ticagrelor or Clopidogrel 300 mg loading dose

Question 10

What dose and for how long do you continue Clopidogrel post STEMI?

Answer 10

75mg/day for 30 days

Question 11

When do you choose fibrinolysis over PCI in STEMI?

Answer 11

If PCI not available within 120 mins.

Question 12

What antithrombin treatment do you give to NSTEMI if NO angiography in next 24 hours?

Answer 12

Fondaparinux

Question 13

If angiography for NSTEMI in next 24 hours what anticoagulant do you give?

Answer 13

Heparin

Question 14

What do you give as second anti-platelet drug in NSTEMI?

Answer 14

Clopidogrel 300mg

Question 15

How long do you continue clopidogrel for post-NSTEMI?

Answer 15

12 months

Question 16

What glycoprotein IIb/IIIa receptor antagonist should patients consider after NSTEMI is intermediate/high risk of CV event or scheduled angiography in next 96 hours?

Answer 16

epitfibatide or tirofiban

Question 17

Warfarin for three months following what MI?

Answer 17

Large anterior MI

Question 18

Drugs started post ACS?

Answer 18

1) Aspirin
2) beta-blocker
3) ACEi
4) Statin

Question 19

how long off driving after successful angioplasty?

Answer 19

1 week

Question 20

Aspirin MOA?

Answer 20

Inhibits production of thromboxane A2 (antiplatlet)

Question 21

What antiplatelet has following MOA:

Inhibits ADP binding to its platelet receptor

Answer 21

Clopidogrel

Question 22

Fondaparinux MOA?

Answer 22

Activated antithromin III - which potentiates inhibition of coagulation factor Xa

Question 23

What drug has following MOA?

reversible direct thrombin inhibitor

Answer 23

Bivalirudin

Question 24

Eptifibatide, abciximab, tirofiban MOA?

Answer 24

Glycoprotein IIb/IIIa receptor antagonist

Question 25

Poor prognostic factors for ACS?

Answer 25

1) age >65 2) History of HF 3) peripheral vascular disease 4) Reduced SBP 5) Killip Class 6) creatinine conc. 7) elevated cardia biomarkers 8) cardiac arrest on admission 9) ST segment deviation

Question 26

What system estimates 6 month mortality in ACS?

Answer 26

GRACE score - decides treatment for NSTEMI, angiography, Eptifibatide/tirofiban use

Question 27

Killip class I?

Answer 27

No clinical signs of heart failure

Question 28

Killip class II?

Answer 28

Lung crackles, S3

Question 29

What Killip class if patient has frank pulmonary oedema?

Answer 29

Class III

Question 30

What emergency if categorised as killip class IV?

Answer 30

Cardiogenic shock

Question 31

Killip Class IV?

Answer 31

Frank pulmonary oedema, SBP <90 mmHg (Cardiogenic shock)