# Acute myocardial infarction - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Referral & Advice) - Acetylsalicylic acid — 300 mg — oral.solid - Glyceryl trinitrate — 0.4 mg — spray ## Complete treatment card ```text ACUTE MYOCARDIAL INFARCTION 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 against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (9) - Sweating and pain radiating to both arms are more typical of MI in men [sweating] - Associated complaints can include lightheadedness, anxiety, cough, a choking feeling, sweating, wheeze, and an irregular heartbeat [anxiety · cough · irregular pulse · sweating · wheeze] - Chest discomfort is usually described as pressure, heaviness, tightness, or squeezing, mainly behind the breastbone [chest pain] - The discomfort often spreads to the shoulders, both arms, the neck, jaw, or the upper belly - Exertion or emotional stress can trigger it and rest usually helps, though it may also strike at rest - Breathlessness, tiredness, nausea, sweating, palpitations, light-headedness, or fainting can stand in for chest pain [breathlessness · chest pain · dizziness · fatigue · nausea · palpitations · sweating · syncope] - An MI can present atypically, and sometimes with no symptoms at all - Older patients more often report breathlessness than chest pain with an MI [breathlessness · chest pain] - In women, an MI can show up as belly pain or light-headedness instead of any chest discomfort [abdominal pain · dizziness] SIGNS - what you find (9) - Heart rate may show a fast rhythm, atrial fibrillation, or a ventricular arrhythmia [arrhythmia] - Unequal pulses can point toward an aortic dissection - Blood pressure is usually raised, but can drop if the patient goes into shock [shock] - Fast breathing and fever may be present as an inflammatory response [fever · tachypnoea] - Distended neck veins suggest right heart failure with a raised central venous pressure [raised JVP] - A displaced apex beat, soft first heart sound, palpable fourth heart sound, or new mitral regurgitation murmur may be found [heart murmur] - A holosystolic murmur that is loud and radiates toward the sternum can point to a ruptured ventricular septum [heart murmur] - Wheeze and crackles on lung exam suggest pulmonary oedema has developed [crackles · oedema · wheeze] - Swelling or a bluish tinge in the limbs, with a feeling of coldness, reflects poor circulation TESTS (11) - ECG is very specific for MI at 95% to 97%, but only about 30% sensitive - Peaked hyperacute T waves signal early ischemia and often go on to ST elevation - ST elevation of more than 2 mm in 2 adjacent leads is a marker of STEMI - STEMI thresholds are ST elevation of 2 mm or more in leads V2 to V3 for men 40 and older, 2.5 mm for younger men, and 1.5 mm for women - Troponin levels peak at about 12 hours and stay elevated for up to 7 days - CK-MB tops out about 10 hours after onset and is back to normal in 2 to 3 days, but it is not used to diagnose MI because of low specificity - LDH peaks after 72 hours and normalizes in 10 to 14 days, and is not used to diagnose acute MI in practice - BNP should not be used to diagnose MI; it is more useful for risk-stratifying patients who go on to develop heart failure - Echocardiography checks wall motion, valve function, mitral regurgitation, and tamponade - A rising or falling troponin, with at least one value above the 99th percentile plus ischemic symptoms, indicates acute MI - Serial troponin at 0, 3, and 6 hours gives a better picture of the severity and timing of injury IF NOT THIS - what else fits (7) - Aortic dissection is a tear in the aortic wall that can obstruct blood flow - Pericarditis can cause chest pain that resembles an MI - Acute cholecystitis can cause right upper quadrant pain radiating to the chest, mimicking cardiac pain - An asthma flare can cause breathlessness, wheeze, and chest tightness mistaken for cardiac symptoms - Myocarditis can present with chest pain and features similar to an MI - A collapsed lung causes sudden chest pain and breathing difficulty that can mimic cardiac disease - Pulmonary embolism can produce chest pain, breathlessness, and other symptoms resembling an MI Source StatPearls "Acute Myocardial Infarction" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult 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. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why 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. Caution 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. 2. ACETYLSALICYLIC ACID [1st line] Adult 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 - Single loading dose before transfer Peds Not applicable. Myocardial infarction is not a paediatric primary-care presentation, and aspirin in a child carries the risk of Reye's syndrome. 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." Why The single highest-value action a GP can take before the ambulance arrives. Chewed and non-enteric-coated so it is absorbed in minutes. Caution 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. Egypt ASPOCID 300 MG 200 TABS. CID 80.00 EGP (0.40/unit) 3. GLYCERYL TRINITRATE [add-on - not a substitute] Adult 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 - While awaiting transfer Peds Not applicable - myocardial infarction is not a paediatric primary-care presentation. 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." Why Relieves ischaemic chest pain while transfer is arranged. Give it only when the blood pressure is in an acceptable range. Caution 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. Egypt NITROLINGUAL 0.4MG/DOSE ORAL SPRAY G.POHL BOSKAMP - GERMANY > SUNNY MEDICAL 30.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)