Morphine in acute MI

Q: Prophylactic use of morphine in acute myocardial infarction(MI) has a beneficial effect and should be used on all patients?

A) True

B) False

Answer: B

Morphine should be used in acute ST Elevation MI only when patient does not get relieved of chest pain from nitrates and oxygen, in case saturation is below 94%. Routine use of morphine should highly be discouraged for two reasons.

1. It may depress respiratory drive and there lies a danger of undue mechanical ventilation.

2. Morphine has shown to diminish the effect of P2Y12 inhibitors.

No data suggests that routine use of morphine reduces mortality.

#cardiology

References:

1. Meine TJ, Roe MT, Chen AY, et al. Association of intravenous morphine use and outcomes in acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. Am Heart J 2005; 149:1043.

2. Kubica J, Adamski P, Ostrowska M, et al. Morphine delays and attenuates ticagrelor exposure and action in patients with myocardial infarction: the randomized, double-blind, placebo-controlled IMPRESSION trial. Eur Heart J 2016; 37:245.

3. Hobl EL, Stimpfl T, Ebner J, et al. Morphine decreases clopidogrel concentrations and effects: a randomized, double-blind, placebo-controlled trial. J Am Coll Cardiol 2014; 63:630.