Chest Pain (Thoracic Pain): Drug Therapy

Therapeutic Targets

  • Pain relief
  • Diagnosis finding

Therapy recommendations

  • Analgesia (analgesics/painkillers) according to WHO staging scheme until definitive therapy when diagnosis is confirmed:
    • Non-opioid analgesic (paracetamol, first-line agent).
    • Low-potency opioid analgesic* (e.g., tramadol) + non-opioid analgesic.
    • High-potency opioid analgesic (e.g., morphine) + non-opioid analgesic.
  • Oxygen; Indications: Patients with hypoxia (SpO2 < 90%), dyspnea or acute heart failure.
  • Antiplatelet therapy (preclinical acetylsalicylic acid (ASA): 150-300 mg orally or 80-150 mg i.v.; indications: V. D. on myocardial infarction.

* Note: Intravenous opioids are still first-line analgesics in suspected myocardial infarction. There is recent evidence that these agents slow the absorption of antiplatelet agents.

Further evidence

  • According to one study, if all patients with acute chest pain were routinely kept in the hospital despite the absence of ischemia and warning signs (abnormal vital signs), at best 1 in 1817 patients (=0.06%) would benefit because of a serious cardiac complication.