Acute Coronary Syndrome Discharge Exercise

Although this exercise can be done blindly it is intended for undergraduates who have just completed a hospital visit looking at acute coronary syndrome (ACS). You are advised to familiarise yourself with the hospital ACS guidelines first of all, then compare them with the treatment the patient actually received.

Study the discharge letter below for a patient admitted to the coronary care unit with ACS, then attempt the 10 questions below:

1	Which of these symptoms did Art present with?	Spina bifida Switch off behaviour Sulphur-oxidising bacteria Shortness of breath

2	Was there any ST elevation observed on the ECG?	Yes No

3	Art was found to have high levels of what in his blood?	Alcohol Potassium Cholesterol Sodium

4	What dosing regime of enoxaparin should this patient have been treated with (assuming renal function is normal).	1mg/kg OD 1mg/kg BD 1.5mg/kg OD 1.5mg/kg BD

5	What ETT did Art have?	Exercise tolerance test Endotracheal tube Eye tracking test Enhanced toilet training

6	What does NRT stand for?	Neutron beam radiotherapy Neural response telemetry Nicotine replacement therapy New reproductive technology

7	What is the total daily dose of beclometasone?	200μg 400μg 800μg 1600μg

8	How long should he receive clopidogrel for?	Just while he is on CCU 12 weeks 12 months Life long

9	What time of the day is the Atorvastatin prescribed? Is this appropriate and why?	Morning Noon Evening Bedtime

10	Which of these drugs would be used first line in the treatment of NSTEMI? Why do you think Art has been put on diltiazem instead?	Steroids ACE inhibitor Loop diuretic β-blocker