General Measures – Relief of Pain and Anxiety

Pain and anxiety contribute to sympathetic over-activity that, in turn, causes vasoconstriction and increases workload of the heart. Therefore, relief of these symptoms, as well as a primary goal of the emergency physician for humane reasons, is physiologically beneficial in the setting of AMI.

Intravenous opiates (diamorphine or morphine) are the drugs of choice. Beta-blockers are also beneficial in this context and have been shown to reduce mortality [2]. Atenolol is commonly used and is given orally in a dose of 12.5-25mgs or intravenously (if the patient is vomiting or rapid blood pressure control is required to facilitate thrombolysis) in a dose of up to 5mgs in repeated 1mg aliquots. Bisoprolol (at a dose of 2.5-10mgs orally) is an alternative beta blocker. Anti-emetics may be co-administered with opiates in the setting of AMI, particularly since patients often suffer with nausea and vomiting as part of the presenting complaint.

Learning Bite

Don’t forget cardiac first aid for patients with ischaemic cardiac pain: aspirin, opiates, oxygen (if oxygen saturation is reduced), GTN and beta-blockers.