[NSTEMI]

Answer 1

ST depression
flat/inverted T waves
or normal

Answer 2

O2 (sats below 90%)

Answer 3

morphine 5-10 mg IV
+
metoclopramide 10mg IV

Answer 4

GTN spray/sublingual (as required)

Answer 5

Aspirin 300mg PO initially then 75mg/day indefinitely
+
(if indicated)
clopidogrel 300mg PO initially then 75mg/day for 12 months

Answer 6

raised troponin
ST depression on ECG
ACS when already on aspirin
ACS after recent MI
Transfered to for angioplasty
Aspirin intolerant

Answer 7

Hypertensive

signs of heart failure (tachycardia, LV function less than 40%)

Answer 8

Asthma
COPD
LVF
bradycardia
coronary spasm

Answer 9

metoprolol 50mg/12hrs

Answer 10

Diltiazem 60-12mg/8hrs PO

Verapamil 80-120mg/8hrs PO

Answer 11

Fondapurinux 2.5mg OD SC daily until discharge

or LMWH/UFH

Answer 12

Factor Xa inhibitor

Answer 13

GTN 50mL in 0.9% saline at 2-10mL/h

intravenous NOT sublingual**titrated

Answer 14

it is titrated against pain

BP must remain >100mmHg systolic

Answer 15

No recurrence of chest pain
No signs of heart failure
Normal ECG present
Normal baseline troponin 6-9-12 hours post pain
No inducible ischaemia

Answer 16

discharge

arrange further testing (angiography)

Answer 17

Rise in troponin
dynamic ST changes or Dynamic T wave changes
2ry criteria (inc. intermediate-high GRACE score)

Answer 18

DM
CKD
LVEF less than 40%
early angina post MI
recent PCI
prior CABG
intermediate-high GRACE score

Answer 19

glycoprotein IIb/IIa inhibitor (e.g. Tirofiban)

angiography within either 120mins/24hrs/72 hrs (inpatient)

Answer 20

doesn’t fill criteria for 120mins/24 hours

Answer 21

GRACE score >140

Answer 22

ongoing angina despite Tx
evolving ST changes
cardiogenic shock signs
life-threatening arrythmias

Answer 23

ACE-i
statin
dual antiplatelet therapy
b-blocker (if LV depressed function)

Answer 24

until discharge

Question 25

[NSTEMI]: how long should GTN be carried on

Answer 25

when stabilised on oral drugs - wean off

Question 26

[NSTEMI]: What Ixs should be done at least >12 hours after the onset of the pain

Answer 26

troponin | serial ECG

Question 27

[NSTEMI]: what modifiable risk factors should you address in preparation for discharge

Answer 27

smoking hypertension hyperlipidaemia diabetes but all of them

Question 28

[NSTEMI]: what does GRACE score stand for

Answer 28

Global Registry of Acute Coronary Events

Question 29

[NSTEMI]: what is the function of the GRACE score

Answer 29

guides future treatment in patients with current ACS: by predicting risk of future death or MI

Question 30

[NSTEMI]: in what format does the GRACE score express the risk of future death?

Answer 30

% chance of dying at 6months, 1yr and 3 yrs after admission

Question 31

[NSTEMI]: what factors influence a patients GRACE score (6)

Answer 31

``` age HR BP renal function heart function biomarkers ``` (90% accuracy!)

Question 32

[NSTEMI]: what initial blood test will you carry out (6)

Answer 32

``` U+E troponin glucose random cholesterol FBC CXR ```

Question 33

[NSTEMI]: why should you NEVER use verapamil and a b-blocker together

Answer 33

asystole inducing