Acute Coronary Syndrome

Question 1

What does Acute Coronary Syndrome include?

Answer 1

Stable Angina
NSTEMI
STEMI

Question 2

What defines a STEMI:
Pathological:
Investigative:

Answer 2

What defines a STEMI:
Pathological: Complete Coronary Occlusion = Severe
Investigative: ST Elevation

Question 3

What defines a NSTEMI:
Pathological:
Investigative:

Answer 3

What defines a NSTEMI:
Pathological: Partial Coronary Occlusion = Minor
Investigative: No ST Elevation

Question 4

Non-modifiable Risk Factors of Acute Coronary Syndrome:
A:
G:
F:

Answer 4

Non-modifiable Risk Factors of Acute Coronary Syndrome:
A: Age
G: Gender/Sex
F: Family History

Question 5

Modifiable Risk Factors of Acute Coronary Syndrome:
D:
O:
S:
H:
H:

Answer 5

Modifiable Risk Factors of Acute Coronary Syndrome:
D: Diabetes
O: Obesity
S: Smoking
H: Hypertension
H: Hyperlipidaemia

Question 6

Acute Coronary Syndrome: dy/dx Diagnosis
APM
APG

Answer 6

Acute Coronary Syndrome: dy/dx Diagnosis
Angina, Pericarditis, Myocarditis
Aortic Dissection, Pulmonary Embolism, Gord

Question 7

Acute Coronary Syndrome Symptoms:
ACCP-R
P
B/D
S
N
D
Note:

Answer 7

Acute Coronary Syndrome Symptoms:
Acute Central Chest Pain - 
Radiates to arm, neck, jaw
Palpitations
Breathlessness/Dyspnoea
Sweating
Nausea
Dizziness
Note: Elderly/Diabetic/Female, may have ACS without chest pain

Question 8

ACS Signs: PARR HFM4

P
A
R
R

HF
M
4

Answer 8

ACS Signs: PARR HFM4
Pallor
Anxiety
Raised/Reduced Pulse
Raised/Reduced BP

Heart Failure
Murmur (Pansystolic)
4th Heart Sound

Question 9

ACS Investigations: BECC
B
E
C
C

Answer 9

ACS Investigations: BECC
Blood: FBC, U & E, Glu, Lipids
ECG
Chest X-Ray
Cardiac Enzymes: Troponin, Myoglobin, Creatine Kinase (CK-MM, CK-BB, CK-MB)

Question 10

Acute Coronary Syndrome Immediate Intervention:

Answer 10

MOAN:
Morphine (Opioids/Analgesics) 
Oxygen if < 93%
Aspirin 300mg orally + Clopidogrel
Nitrate (Nitroglycerate - GNT spray/tablet)

Question 11

Acute Coronary Syndrome Treatment Types: 
M
O
A
N
-
P
C
T
MRFA

Answer 11

Acute Coronary Syndrome Treatment Types:
Morphine (Opioids)
Oxygen (acute)
ACE-Inhibitors
Anti-Platelet: Aspirin, Clopidogrel, Prasugrel, Ticagrelor
Nitrates - GTN
-
PCI (1st)
CABG (if PCI fails)
T (2nd in 4.5hrs) (anti-Thrombotics): Heparin, LmwH, Fondaparinux,
MRFA: Modifiable Risk Factor Adjustment: Smoking, Weight, Diet, Diabetes, Hypertension, Hyperlipidaemia.

Question 12

Acute Coronary Syndrome Treatment Types: for STEMI
BB
A
PA
AP-C

Answer 12

Acute Coronary Syndrome Treatment Types: for STEMI
BB: Beta Blockers
A: Angiotensin Converting Enzyme Inhibitors
PA: Primary Angioplasty
AP-C: Antiplatelet- Clopidogrel

Question 13

Acute Coronary Syndrome Treatment Types: for NSTEMI
BB
AT
AP
GpII/IIIa

Answer 13

Acute Coronary Syndrome Treatment Types: for NSTEMI
BB: Beta Blockers
AT: Anti-Thrombotics: LmwH, Fondaparinux
AP: Anti-Platelet: Aspirin, Clopidogrel
GpII/IIIa Antagonist

Question 14

Monitoring & Ongoing Management of ACS Patient: BED-PAB
BR
E
D
P
A
B

Answer 14

Monitoring & Ongoing Management of ACS Patient: BED-PAB
Bed Rest
ECG
Daily examination - Heart, Lungs, Legs
Prophylaxis - thromboembolism 
Aspirin
Beta Blockers