Question

What drug treatment would you expect to administer for the pain associated with Myocardial Infarction?

Answer 1

Acute myocardial infarction (AMI) is a cardiac emergency AND the classical squeezing, a “burning” feeling and chest pain is the most common presenting complaint of acute myocardial infarction whis is radiating to left shoulder, neck and left arm.

As the severity ot the chest pain is too severe so its prompt treatment is become the crucial as an essential part of the management.

Rapid and effective management of pain prevent detrimental pathophysiologic effects like increases in blood pressure, heart rate, and stroke volume and idisruption of the physiological effects causes balance between myocardial oxygen supply and demand, and therefore result in the progression of infarction.

now discuss the management of pain in AMI....

1. NARCOTIC ANALGESIC...MORPHINE

In 1923 when James MacKenzie first suggested use of morphine and chloroform for treating cardiac patients with bed rest.. Since then morphine has been considered as one of the first line medications recommended for pain control in AMI.

Morphine reduces the blood pressure, slowing heart rate, and relieving anxiety, so ultimately decrease myocardial oxygen demand.

BUT later on due to some negative outcomes associated with morphine administration in AMI, include decrease in myocardial oxygen delivery, decrease of arterial oxygenation, increase in arterial carbon dioxide, and perhaps even cerebral hypoperfusion..so alternatives for analgesia in acute MI had to be suggested...

alternatives for analgesia in acute MI....

1. Non-steroidal antiinflammatory drugs (NSAIDs)....in NSAIDs, Ketorolac and indoprofen were amongst the earliest which suggesting for pain management in MI.BUT later on as due to the increased risk for cardiovascular events the use of NSAIDs is limited in AMI pain management..

now again search for  alternative strategies for analgesia in AMI.....

1. IV nitrates and Beta-blockers.... As Ischemia being the main etiology behind chest pain in AMI, reperfusion therapy in AMI by use of nitrates and beta blocker relief the pain in AMI.

2. IV Acetaminophen (the safest Analgesic)......

3. Opiates....AS tramadol, Tapentadol etc

4. Combinations .. ...as tramadol hydrochloride and acetaminophen (37.5 mg + 325 mg) ...