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Is pre-hospital treatment of chest pain optimal in acute coronary syndrome? Both relief of pain and anxiety are needed
University of Borås, School of Health Science.
University of Borås, School of Health Science.
University of Borås, School of Health Science.
2011 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 149, no 2, 147-151 p.Article in journal (Refereed)
Abstract [en]

Background Many patients who suffer from acute chest pain are transported by ambulance. It is not known how often treatment prior to hospital admission is optimal and how optimal pain-relieving treatment is defined. It is often difficult to delineate pain from anxiety. Aim To describe various aspects of chest pain in the pre-hospital setting with the emphasis on a) treatment and b) presumed acute coronary syndrome. Methods In the literature search, we used PubMed and the appropriate key words. We included randomised clinical trials and observational studies. Results Four types of drug appear to be preferred: 1) narcotic analgesics, 2) nitrates, 3) beta-blockers and 4) benzodiazepines. Among narcotic analgesics, morphine has been associated with the relief of pain at the expense of side-effects. Alfentanil was reported to produce more rapid pain relief. Nitrates have been associated with the relief of pain with few side-effects. Beta-blockers have been reported to increase the relief of pain when added to morphine. The combination of beta-blockers and morphine has been reported to be as effective as beta-blockers alone in pain relief, but this combination therapy was associated with more side-effects. Experience from anxiety-relieving drugs such as benzodiazepines is limited. It is not known how these 4 drugs should be combined. The results indicate that various pain-relieving treatments might modify the disease. Conclusion Our knowledge of the optimal treatment of chest pain and associated anxiety in the pre-hospital setting is insufficient. Recommendations from existing guidelines are limited. Large randomised clinical trials are warranted.

Place, publisher, year, edition, pages
Elsevier Ireland Ltd , 2011. Vol. 149, no 2, 147-151 p.
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:hb:diva-2911DOI: 10.1016/j.ijcard.2010.10.012Local ID: 2320/7226OAI: oai:DiVA.org:hb-2911DiVA: diva2:871005
Available from: 2015-11-13 Created: 2015-11-13

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Herlitz, JohanWireklint Sundström, BirgittaBång, Angela
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Citation style
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