Pain assessment in acute myocardial infarction patients

doi:10.1016/S0964-3397(95)81693-3

Intensive and Critical Care Nursing

Volume 11, Issue 5, October 1995, Pages 252-255

https://doi.org/10.1016/S0964-3397(95)81693-3 Get rights and content

The purpose of this study was to investigate the pain intensity and duration, and to assess the pain control intervention, in patients with acute myocardial infarction (AMI).

Methods:

Ninety-seven patients (18 diabetics and 79 non-diabetics) admitted to the hospital with chest pain were included in this study. Pain was measured on the numerical rating scale (NRS) 0–10, where 0 means no pain and 10 unbearable pain. All patients were followed for 12 hours, after the last chest pain episode. The data were statistically evaluated with the Student's t-test and chi square (χ²).

Results:

The pain in AMI patients with diabetes mellitus was lower in intensity (P < 0.002) and shorter in duration (P < 0.000) respectively, compared with the non-diabetic AMI patients. The intensity of pain in patients with an anterior infarction tended to be higher (P < 0.03) than in those with an inferior infarction. Finally, the systolic blood pressure fell si gnificantly (P < 0.000) 90 min after admission. No other significant differences were found.

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Blood samples were measured centrally, and peak values and areas under the curve were calculated. The degree of chest pain before PCI and at the time of first achievement of TIMI 2/3 was evaluated using a numerical rating scale [22]. In addition, any cases of ventricular arrhythmia (NSVT/SVT and Vf/VF) which occurred after study drug administration were recorded.
In myocardial ischemia–reperfusion injuries, the involvement of the Na⁺/H⁺ exchanger (NHE) is considered to be one of the pathogenic mechanisms following reperfusion. TY-51924 is a novel hydrophilic NHE inhibitor with a lower risk of central neurotoxicity than previous NHE inhibitors. This open-label, dose-escalating study was undertaken to investigate the safety, efficacy, and pharmacokinetics of TY-51924 in patients with ST-elevation myocardial infarction (STEMI).
Consent was obtained from a total of 30 patients with first anterior STEMI. After 12 patients were determined to be ineligible, the remaining 18 patients, each of whom was undergoing primary percutaneous coronary intervention (pPCI), received TY-51924 intravenously up to 10, 20, or 30 mg/kg as the low-, medium-, or high-dose groups, respectively (n = 6 in each group). The primary endpoints were safety (up to 7 days) and plasma drug concentration. The myocardial salvage index (MSI) was measured by ²⁰¹Tl/¹²³I-beta-methyl-p-iodophenyl pentadecanoic acid single photon emission computed tomography (SPECT) 3–5 days after pPCI.
No side effects were observed. Plasma drug concentrations increased dose-dependently, and were subsequently eliminated rapidly. MSIs were 0.118, 0.335, and 0.192 in the low-, medium-, and high-dose groups, respectively. In additional analysis, the combined MSIs in the medium- and high-dose groups were significantly higher than those in the low-dose group, in patients with a longer time from symptom onset to reperfusion (p = 0.0247).
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Parameters listed in Table 4 are to be assessed in accordance with the schedule of assessments (Table 2). Then chest pains are to be evaluated using a numerical rating scale [21] and re-admission due to heart failure is diagnosed using the Framingham criteria [22]. Endpoints in this trial are listed in Table 5.
Reperfusion therapy limits infarct size and improves survival in patients with ST-elevation myocardial infarction (STEMI). However, reperfusion itself may, in some cases, deteriorate myocardial damage, causing the so-called ischemia-reperfusion injury. Activation of the Na⁺/H⁺ exchanger (NHE) at the time of reperfusion plays an important role in ischemia-reperfusion injury. We designed a Phase IIa proof of concept clinical trial to evaluate the potential of TY-51924, an NHE inhibitor, as adjunctive therapy to primary percutaneous coronary intervention (pPCI) for patients with STEMI.
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Many patients and physicians are familiar with the NRS where 0 means no pain and 10 means the most severe pain imaginable. The NRS is easy to learn and is thus applicable in assessing a wide variety of medical conditions including myocardial infarction,11 rheumatoid arthritis12 and cancer pain.13 The NRS has been used in the assessment of various pharmacologic13-16 and nonpharmacologic interventions.17
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Frequency of silent myocardial ischemia with 12-lead ST segment monitoring in the coronary care unit: Are there sex-related differences?
1999, Heart and Lung: Journal of Acute and Critical Care
Background: Ischemia that occurs in the coronary care unit (CCU), whether symptomatic or silent, is associated with significant in-hospital and out-of-hospital complications. Studies have reported that more than 90% of ischemic episodes are silent in patients with unstable angina who are treated in the CCU with maximal medical therapy. Prior reports indicate that women complained more frequently of chest pain than men did. Purpose: The aim of this study was to compare the frequency of silent myocardial ischemia in men versus women with use of continuous 12-lead ST segment monitoring in the CCU. A secondary goal was to determine whether silent ischemia was associated with less ST segment deviation as compared with symptomatic ischemia. Method: Patients admitted for treatment of acute coronary syndrome in the CCU and who subsequently had 1 or more ischemic events during their monitoring period were selected for this analysis. All patients were continuously monitored (42.5 hours ± 37.6) in the CCU with the EASI (Zymed Medical Instruments, Camarillo, Calif) 12-lead electrocardiogram (ECG) system that derives 12 leads with use of 3 information channels and 5 electrodes. Results: Of 491 patients, 128 (91 men and 37 women) had at least 1 episode of transient myocardial ischemia. Men and women did not differ in their proportion of chest pain during ischemia (men 27% and women 21%, NS). For both men and women, ST segment deviation was significantly greater during symptomatic ischemia compared with silent ischemia. Conclusion: There are no sex-related differences in ischemic events in the CCU in regards to the variables of chest pain and ST magnitude. Therefore, because chest pain is not a reliable indicator of myocardial ischemia in the CCU, regardless of sex, patients should be adequately monitored for ischemic events. (Heart Lung^® 1999;28:81-6)
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Pain assessment in acute myocardial infarction patients

Methods:

Results:

Intensive and Critical Care Nursing

American Heart Journal

Intensive Care Nursing

American Heart Journal

American Heart Journal

International Journal of Cardiology

American Journal of Cardiology

Guidelines for the early management of patients with acute myocardial infarction

Circulation

Association between silent coronary artery disease, diabetes, and autonomic neuropathy

Diabetes Care

Analgesics in acute phase of myocardial infarction

Journal of American Medical Association

Diminished pain in diabetic patients with myocardial infarction

Geriatrics

Painless myocardial infarction in diabetes melitus

A myth?

Danish Medical Bulletin

Pathophysiology of silent myocardial ischemia during daily life

Hemodynamic evaluation by simultaneous electrocardiographic and blood pressure monitoring

Circulation

Programmed instruction; cancer pain

Cancer Nursing