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Treatment for Acute Coronary Syndrome on the Physician Assistant Exam

Many of the Physician Assistant Exam questions concerning acute coronary syndrome involve evaluation, treatment, or both. Because the treatment of acute coronary syndrome overlaps so much with so many conditions, much of the focus is on recognizing clinical presentation and ECG changes. Here are some key points for treating different aspects of acute coronary syndrome:

  • The standard of care treatment for a STEMI is a trip to the cardiac catheterization lab for an emergent cardiac catheterization, with angioplasty and possible stent. If you’re practicing in an area where a cardiac catheterization lab isn’t readily available, then the second-line treatment is thrombolysis with a medication like tPA.

  • Statin therapy is usually administered in the setting of an MI. A lipid profile is usually ordered if the patient has been fasting or within 24 hours of admission when someone presents with acute coronary syndrome. If the LDL-C is >= 100 mg/dL, a statin should be prescribed on hospital discharge.

  • Clopidogrel (Plavix) is an antiplatelet agent that’s routinely given, along with aspirin, in the treatment of a STEMI. Clopidogrel can be maintained for a while, especially to reduce clotting off of a cardiac stent if a stent has been placed. An uncommon side effect of clopidogrel is thrombotic thrombocytopenic purpura (TTP) — rare but possible.

In variant angina, or Prinzmetal’s angina, a person comes in with crushing chest pressure. ECG changes indicate an acute coronary syndrome, and there may be an enzyme leak (that is, positive troponins and CK-MB fraction).

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