{ "schema_version": 1, "kind": "condition", "id": "acute-myocardial-infarction", "name": "Acute myocardial infarction", "category": "chronic", "sources": "Acute Myocardial Infarction - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK459269/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class KD65.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care", "review_status": "reviewed", "verified_against": "No dose - referral pathway, no medicine given in primary care", "verified_date": "2026-08", "treatments": [ { "id": 59, "generic": "No drug therapy in primary care (Referral & Advice)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "This is a life-threatening emergency. A Cairo GP's role is immediate recognition, first-aid medication, and urgent transfer to a facility with cardiac catheterisation, not definitive treatment in clinic.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "This is a life-threatening emergency. A Cairo GP's role is immediate recognition, first-aid medication, and urgent transfer to a facility with cardiac catheterisation, not definitive treatment in clinic.", "cautions": [ "Central chest pain with sweating or radiation to arm/jaw, ECG changes, hypotension, signs of cardiogenic shock.", "Definitive treatment - thrombolysis, angioplasty, anticoagulation - is decided by the receiving service. Before transfer, give chewed aspirin, and sublingual GTN if the blood pressure allows." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children follow the same pathway: recognise and refer. No primary-care medicine is implied.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "acute-myocardial-infarction" }, { "id": 60, "generic": "Acetylsalicylic acid", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 300.0, "adult_dose": "300 mg chewed once, immediately, while arranging transfer. The source states a loading dose of 162 mg to 325 mg; 300 mg is the strength stocked in Egypt and sits inside that range", "adult_duration": "Single loading dose before transfer", "dose_source": "Acute Myocardial Infarction - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK459269/ - verbatim: \"All patients with STEMI and NSTEMI require immediate administration of nonenteric-coated, chewable aspirin with a loading dose of 162 mg to 325 mg.\"", "rationale": "The single highest-value action a GP can take before the ambulance arrives. Chewed and non-enteric-coated so it is absorbed in minutes.", "cautions": [ "Do not give if there is active gastrointestinal bleeding or a known aspirin allergy.", "Giving aspirin must not delay the call for transfer - it is done while arranging it, not before it.", "Chewed, not swallowed whole, and not the enteric-coated tablet: the source specifies non-enteric-coated and chewable." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable. Myocardial infarction is not a paediatric primary-care presentation, and aspirin in a child carries the risk of Reye's syndrome.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "ASPOCID 300 MG 200 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 80.0, "pack_count": 200, "unit_price": 0.4, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "acute-myocardial-infarction" }, { "id": 61, "generic": "Glyceryl trinitrate", "line": 1, "is_adjunct": true, "form": "spray", "strength_mg": 0.4, "adult_dose": "One or two metered sprays (400 to 800 micrograms) under the tongue, repeatable at five-minute intervals to a maximum of three sprays (1.2 mg within 15 minutes) - ONLY if the blood pressure is in an acceptable range", "adult_duration": "While awaiting transfer", "dose_source": "Glyceryl Trinitrate Spray 400 micrograms/metered dose sublingual spray SmPC section 4.2 (eMC product 674) for the dose; indication in this setting from Acute Myocardial Infarction - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK459269/ - verbatim: \"Opioids may be used for pain control in addition to sublingual nitroglycerin if the patient's blood pressure is within an acceptable range.\"", "rationale": "Relieves ischaemic chest pain while transfer is arranged. Give it only when the blood pressure is in an acceptable range.", "cautions": [ "Do NOT give if the patient is hypotensive. The source permits it only when blood pressure is within an acceptable range.", "Do NOT give within 24 hours of sildenafil or another PDE5 inhibitor (48 hours for tadalafil) - the combination causes profound hypotension.", "Particular care in inferior or right-ventricular infarction, where the circulation is preload-dependent and a nitrate can drop the blood pressure sharply.", "It relieves pain; it does not treat the infarct. Transfer is still immediate." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable - myocardial infarction is not a paediatric primary-care presentation.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "NITROLINGUAL 0.4MG/DOSE ORAL SPRAY", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "G.POHL BOSKAMP - GERMANY > SUNNY MEDICAL", "price_egp": 30.0, "pack_count": null, "unit_price": null, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "acute-myocardial-infarction" } ] }