ACS Risk scoring

All scoring systems make good SAQs as there are different things to ask such as components, what carries more weight and asking why is it useful.

Both TIMI and GRACE help predict the mortality/ further consequences in patients with suspected or confirmed ACS. In the ED perhaps they are most useful for helping to support a safe discharge of a person with trop negative chest pain. After all a STEMI will be referred regardless of their GRACE score.

Nice recommend the GRACE score which is worked out via normograms and therefore usually computer generated after the inputs are entered. It is also worth knowing the Khilip classification of heart failure (an easy SAQ: outline the Khilip classification of heart failure)

1. No heart failure
2. Mild- moderate heart failure
3. Pulmonary oedema
4. Cardiogenic Shock

The Timi Score has come up in previous questions and lends it self very well as one point is assigned to each feature making it easy it calculate. The risks range from 5% for 1 point, up to 41% for 6/7 points.

Question:

A 54 year old male smoker presents with an episode of central chest pain whilst walking his dog. He felt sweaty, clammy and nauseous at the time.

1) What are the indications on ECG for PCI? (3)

2) What initial treatments should be given in the ED? (3)

3) List three  further features of history you would like to enable you to calculate his risk of death and name the scoring system you would use. (4)