ACS Quiz

A 70yr old man presents to A&E in a large tertiary hospital with a 3 hour history central chest tightness, radiating down his left arm. He is sweaty and nauseous. The pain has not responded to repeated doses of his own GTN. On examination he is pale and clammy, HR 110bpm, BP 107/59. Otherwise his examination is grossly normal. ECG shows ST elevation across leads V1 – V5, with reciprocal ST depression in lead III. Trop T is elevated at 430. What is the gold standard therapy for this man’s problem?

• Aspirin 300mg and Clopidogrel 300mg STAT

• PCI

• GTN infusion

• Fondaparinux

Answer explanation

The history and investigation findings are consistent with an anterolateral STEMI.

The gold standard therapy for this is urgent reperfusion by PCI if it is available.

Which of the following is not used in secondary prevention of a MI?

• Beta blockers

• ARBs

• Calcium channel blockers

• Statins

• Dual antiplatelets

What score is used to estimate mortality for patients with acute coronary syndrome?

• Wells

• Grace

• Gleason

• CHADS-VASC

A patient has chest pain for 2 hours. An ECG shows ST-elevation in leads I,II and AVF. What artery is affected?

• Left anterior descending artery

• Right coronary

• Left coronary

• Circumflex artery

Answer explanation

What is the difference between unstable angina and NSTEMI?

• Unstable angina has reversible myocardial injury, NSTEMI the injury is irreversible

• ECG will be normal in unstable angina, there will be ST elevation in NSTEMI

• ECG will be normal in unstable angina, there will be ischaemic changes in NSTEMI

• Troponin in unstable angina will be normal, it will be raised in NSTEMI

What can cause a raised troponin?

• Aortic dissection

• Myocardial infarction

• Hypertrophic cardiomyopathy

• Stroke