Chest Pain in Acute Myocardial Infarction

Herlitz, Johan

doi:10.1159/000174633

Cited by 6 publications

(5 citation statements)

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“…Earlier studies have also suggested that some subgroups of patients such as those with smaller infarcts (Herlitz et al, 1984;Nielsen et al, 1990) and elderly patients (Bayer, 1988) have less severe pain. Moreover, previous studies have shown that patients with larger infarcts according to maximal serum enzyme activity and development of Q waves had more severe pain initially, a longer duration of pain and a higher morphine requirement (Herlitz et al, 1984;Bondestam et al, 1987;Hofgren et al, 1988;Herlitz, 1990). In addition, a more severe pain course has been associated with more intensive pain at home, ECG signs of AM1 on admission to hospital and a high systolic blood pressure or a high rate-pressure product on admission (Hofgren et al, 1988;Herlitz, 1990).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, previous studies have shown that patients with larger infarcts according to maximal serum enzyme activity and development of Q waves had more severe pain initially, a longer duration of pain and a higher morphine requirement (Herlitz et al, 1984;Bondestam et al, 1987;Hofgren et al, 1988;Herlitz, 1990). In addition, a more severe pain course has been associated with more intensive pain at home, ECG signs of AM1 on admission to hospital and a high systolic blood pressure or a high rate-pressure product on admission (Hofgren et al, 1988;Herlitz, 1990). Surprisingly, 52.4% of all patients in the present study required no morphine analgesia at all.…”

Section: Discussionmentioning

confidence: 99%

“…The evaluation of the intensity and duration of chest pain by analyses of morphine consumption is likely to give a fairly reliable estimate of the clinical pain course in hospital (Herlitz, 1990;Nielsen et al, 1990;Karlson et al, 1993). Such an estimate could of course be criticized, since it has been reported that some patients with severe chest pain do not ask for adequate pain relief (Bondestam et al, 1987).…”

Section: Discussionmentioning

confidence: 99%

“…Morphine is generally considered as the opioid analgesic of choice in the management of acute chest pain due to definite or suspected AM1 (Petch, 1989;Herlitz, 1990). In spite of long and extensive use, knowledge is still lacking regarding predictors of consumption, duration of pain relief, time between drug administration and pain relief, as well as optimal doses to patients with myocardial ischaemia or those developing AM1 (Herlitz, 1989).…”

Section: Introductionmentioning

confidence: 99%

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Morphine use and pharmacokinetics in patients with chest pain due to suspected or definite acute myocardial infarction

Everts

Karlson

Herlitz

et al. 1998

European Journal of Pain

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The characteristics of chest pain due to suspected acute myocardial infarction and morphine use during the first 3 hospital days are described in a population of 2988 consecutive patients admitted to hospital. The duration of pain was usually less than 24 h (mean 20.9+/-0.55 h), and only 24.8% of patients experienced chest pain of longer duration. The majority of patients had only one attack of pain, but 34.4% experienced four or more attacks during hospitalization. A mean morphine dose of 6.7+/-0.2 mg was administered over the 3 hospitalization days, but surprisingly 52.4% of all patients required no morphine analgesia at all. Independent predictors of an increased morphine consumption were initial degree of suspicion of acute myocardial infarction, ST changes on admission ECG, male sex, a history of angina pectoris and a history of congestive heart failure. In a separate pharmacokinetic/pharmacodynamic study in 10 patients, plasma concentrations of morphine and its major metabolites, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G), were measured after intravenous administration of morphine. In this patient group, terminal half-life of unchanged morphine ranged from 0.77 to 3.22 h. M3G and M6G plasma concentrations increased gradually up to 60-90 min after the intravenous morphine injection. Initial pain intensity by numerical rating scale was 6.6+/-0.6 (arbitrary units), and after morphine administration, there was a rapid and significant decrease in pain intensity. After 20 min, pain relief was 69+/-11% and remained at this level during the following 8 h observation period. It is concluded that the need for morphine administration in patients with suspected or definite acute myocardial infarction, differs among subgroups of patients and, in particular, higher doses are needed in those with a strong suspicion of myocardial infarction at arrival. When intravenous morphine is given, it attains full effect 20 min after injection. Furthermore, the active morphine metabolites M3G and M6G appear rapidly in the circulation, which could influence the analgesic response to morphine treatment. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Morphine use and pharmacokinetics in patients with chest pain due to suspected or definite acute myocardial infarction

Everts

Karlson

Herlitz

et al. 1998

European Journal of Pain

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“…Earlier reports indicate that the intensity of pain is most severe before hospital admission [3]. A variety of treatment alternatives, including nitrates [4], narcotic analgesics [5], b-blockers [6], and benzodiazepines [7], are available. Knowledge about the impact of various pain-relieving strategies on the relief of pain in the early phase of ACS is insufficient.…”

Section: Introductionmentioning

confidence: 99%

Aspects on the intensity and the relief of pain in the prehospital phase of acute coronary syndrome: experiences from a randomized clinical trial

Zedigh

Alho

Hammar

et al. 2010

Coronary Artery Disease

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The primary aim of this study was to evaluate the pain relief and tolerability of two pain-relieving strategies in the prehospital phase of presumed acute coronary syndrome (ACS), and the secondary aim was to assess the relationship between the intensity and relief of pain and heart rate, blood pressure, and ST deviation. Patients with chest pain judged as caused by ACS were randomized (open) to either metoprolol 5 mg intravenously (i.v.) three times at 2-min intervals (n = 84; metoprolol group) or morphine 5 mg i.v. followed by metoprolol 5 mg three times i.v (n = 80; morphine group). Pain was assessed on a 10-grade scale before randomization and 10, 20, and 30 min thereafter. The mean pain score decreased from 6.5 at randomization to 2.8 30 min later, with no significant difference between groups. The percentages with complete pain relief (pain score < or = 1) after 10, 20, and 30 min were 11, 16, and 21%, respectively, with no difference between groups. Hypotension was less frequent in the metoprolol group compared with the morphine group (0 vs. 6.3%; P=0.03), as was nausea/vomiting (7.2 vs. 24.0%; P=0.004). At randomization intensity of pain was associated with degree of ST elevation (P=0.009). The degree of pain relief over 30 min was associated with decrease in heart rate (P=0.03) and decrease in ST elevation (P=0.01).In conclusion, in the prehospital phase of presumed ACS, neither a pain-relieving strategy including an anti-ischemic agent alone nor an analgesic plus anti-ischemic strategy in combination resulted in complete pain relief. Fewer side effects were found with the former strategy. Other pain-relieving strategies need to be evaluated.

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Is pre-hospital treatment of chest pain optimal in acute coronary syndrome? The relief of both pain and anxiety is needed

Herlitz

Bång

Ömerovic

et al. 2011

International Journal of Cardiology

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Chest Pain in Acute Myocardial Infarction

Cited by 6 publications

References 6 publications

Morphine use and pharmacokinetics in patients with chest pain due to suspected or definite acute myocardial infarction

Morphine use and pharmacokinetics in patients with chest pain due to suspected or definite acute myocardial infarction

Aspects on the intensity and the relief of pain in the prehospital phase of acute coronary syndrome: experiences from a randomized clinical trial

Is pre-hospital treatment of chest pain optimal in acute coronary syndrome? The relief of both pain and anxiety is needed

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