Acute Coronary Syndromes

Question 1

Types of ACS

Answer 1

STEMI
NSTEMI
Unstable angina

Question 2

Risk factors

Answer 2

Family history
Hypertension
Hypercholesterolaemia
Diabetes
Smoking

Question 3

What is the timeframe for PCI to be performed in a STEMI and NSTEMI?

Answer 3

STEMI = 2 hours
NSTEMI = within 72 hours

Question 4

Initial management of STEMI/NTEMI

Answer 4

Loading dose of aspirin 300mg
Pain relief GTN +/- IV morphine
Low oxygen sats = oxygen administered (not routinely done)

Fondaparinux if NSTEMI

Question 5

Difference between STEMI and NSTEMI/Unstable angina

Answer 5

STEMI: Complete blockage of artery causing myocardial necrosis
NSTEMI/Unstable angina: Partial blockage of artery

Question 6

Why should a PCI be performed within 2 hours of a STEMI?

Answer 6

The patient will undergo a lot of damage to heart muscles and deprive heart of oxygen, increasing mortality risk

Question 7

When should a patient be given heparin before PCI

Answer 7

If the PCI is done through radial access

Question 8

What is the preferred secondary anti-platelet for long-term management after PCI?

Answer 8

Prasugrel

Question 9

Secondary prevention of CVD

Answer 9

Dual antiplatelet therapy
o Lifelong: aspirin
o 12 months: clopidogrel, prasugrel (if PCI), ticagrelor
o Rivaroxaban can also be used with either aspirin alone or aspirin and clopidogrel

Antihypertensive treatment - titrated to max tolerated dose
o 1st: ACE-I
o 2nd: ARB

Beta blocker - titrated to max tolerated dose
o May be discontinued after 12 months in patients without reduced LVEF
o RL-CCB may be considered as alternative IF patient does not have pulmonary congestion or a reduced LVEF

Statin: High intensity (atorvastatin 80mg)

Question 10

What should the patient be assessed for after an ACS event?

Answer 10

Heart failure - via echo

Question 11

Which fibrinolytic drugs are licensed for use in acute MI? Are they used more in STEMI or NSTEMI?

Answer 11

Streptokinase
Altepplase
Reteplase
Tenecteplase

STEMI