nicomorphine and Myocardial-Infarction

In a randomized double-blind study with flexible dosage, morphine, nicomorphine and pethidine were compared with regard to analgetic effect, dose requirements, dose intervals and adverse reactions. A total of 275 patients were included, and 28 patients were excluded due to adverse reactions (n = 16) and for practical reasons, etc. Acute myocardial infarction (AMI) was diagnosed in about 60% of the patients, and about 30% had ischemic heart disease without AMI. All three analgesics provided equally efficient pain relief in relative doses of morphine 10, nicomorphine 10 and pethidine 75 mg/ml. Severe adverse reactions were few (allergy 3 cases, respiratory insufficiency 4, severe bradycardia 4), whereas nausea was recorded in 20-30%, vomiting in 5-15% and dizziness in 10-30% of the patients, with no difference between the three drugs. Significant blood pressure drop (greater than 30 mmHg) was seen in 3-8% of the patients, with no significant differences between the drugs.

Topics: Aged; Clinical Trials as Topic; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Male; Meperidine; Middle Aged; Morphine; Morphine Derivatives; Myocardial Infarction; Nicotinic Acids; Random Allocation

Treatment with intravenous streptokinase is known to restore blood flow to the ischaemic myocardium in patients with acute myocardial infarction. However, little is known about its effect on chest pain. In a retrospective cohort study, 76 patients treated with streptokinase were compared to 76 patients not treated with streptokinase. All patients had acute myocardial infarction and less than 6 h of cardiac symptoms. Patients treated with streptokinase had a significantly lower need for nicomorphine (median 20 mg) than patients not treated with streptokinase (median 41 mg). Correspondingly, the median duration (3.5 h) of pain was reduced significantly in patients treated with streptokinase compared to patients not treated (24 h). We conclude that intravenous streptokinase given in the acute phase of myocardial infarction is effective in reducing the duration of cardiac chest pain.

Topics: Acute Disease; Aged; Chest Pain; Cohort Studies; Female; Humans; Injections, Intravenous; Male; Middle Aged; Morphine Derivatives; Myocardial Infarction; Nicotinic Acids; Retrospective Studies; Streptokinase

Topics: Adult; Aged; Aged, 80 and over; Arrhythmias, Cardiac; Blood Pressure; Chest Pain; Electrocardiography; Female; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Morphine Derivatives; Myocardial Infarction; Nicotinic Acids; Pain Measurement