Acute coronary syndrome

• What sex is acute coronary syndrome more common in?

  Males
• What age range are acute coronary syndromes most common in?

  60-70
• What are some non-modifiable risk factors for developing acute coronary syndromes?

  Age (older)

  Male

  Family history
• What are some modifiable risk factors for developing acute coronary syndromes?

  Smoking

  Diabetes

  Hypertension

  Hypercholesterolaemia

  Obesity
• ACS generally develops in patients who have what condition?

  Ischaemic heart disease
• What are some classical features of ACS?

  Chest pain

  Dyspnoea

  Nausea and vomiting

  Sweating

  Palpitations
• Describe the chest pain in ACS

  Classically on the left side of the chest - May radiate to left arm or neck

  Characteristics: Pressure, tightness, or crushing sensation
• What would hypotension indicate with ACS?

  Cardiogenic shock
• What may hypertension indicate with ACS?

  Stress response
• Is tachycardia common in ACS? and why is it bad?

  Yes - worsen ischaemia
• When may bradycardia be present in ACS?

  Inferior myocardial infarction due to vagal activation
• What investigation is normally done for ACS?

  ECG
• What would an ECG show for an acute MI?

  ST elevation

  Inverted T waves

  Pathological Q waves
• Fill in the table

  A) V1-V4

  B) L ant descending

  C) II

  D) III

  E) aVF

  F) R coronary

  G) V1-6

  H) I

  I) aVL

  J) Proximal L ant descending

  K) I

  L) aVL

  M) V5-6

  N) L circumflex

  O) V1-3

  P) L circumflex

  Q) R coronary

  
• Fill in the gaps

  A) Circumflex

  B) Lateral

  C) R coronary

  D) Inferior

  E) L ant descending

  F) Anterior

  
• What are 3 ddx of ACS?

  Aortic dissection

  Pulmonary embolism

  GORD
• What can ACS be classified as?

  STEMI

  NSTEMI

  Unstable angina
• What is the management for an ACS dependent on?

  STEMI vs NSTEMI/unstable angina
• What is the common management for all patients with ACS?

  300mg aspirin

  Oxygen (if O2 sats are <94%)

  Morphine

  Nitrates
• How is a STEMI managed?

  PCI

  Thrombolysis
• When is PCI offered?

  Presentation is within 12 hours of symptom onset and PCI can be delivered within 120 mins
• When should thrombolysis be offered?

  Presentation is within 12 hours of symptom onset and PCI cannot be given with 120 mins
• What antiplatelets may be given prior to a PCI and what is this called?

  Dual antiplatelet therapy

  Aspirin + another drug
• What drug is given for dual antiplatelet therapy if the patient is NOT taking an oral anticoag?

  Prasugrel
• What drug is given for dual antiplatelet therapy if the patient is taking an oral anticoag?

  Clopidogrel
• What is the management for NSTEMI/unstable angina?

  Depends on the individual patient - normally antithrombin treatment
• What tool is used for ASC risk assessment?

  Global registry of acute coronary events
• What does GRACE take into account?

  Age

  HR and BP

  Cardiac (Killip class) and renal function (serum creatinine)

  Cardiac arrest on presentation

  ECG findings

  Troponin levels
• What are some complications following an ACS?

  Arrhythmias

  Heart failure

  Angina

  Left vent aneurysm

  Pericarditis

  Cardiac arrest
• What is the Killip class?

  System used to stratify risk post MI
• Fill in the gaps

  A) No clinical signs

  B) Lung crackles

  C) Frank pulmonary oedema

  D) Cardiogenic shock