Why is morphine given to a cardiac patient?

From the Guidelines

Morphine is given to cardiac patients primarily to relieve chest pain and reduce anxiety, which can help lower the heart's workload, with a typical dose of 1 to 5 mg administered intravenously, as recommended by the 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes 1.

Key Points

• Morphine has potent analgesic and anxiolytic effects, as well as hemodynamic actions, that are potentially beneficial in non-ST-elevation acute coronary syndromes (NSTE-ACS) 1.
• It causes venodilation and produces modest reductions in heart rate and systolic blood pressure, which can help reduce myocardial oxygen demand 1.
• The dose of morphine may be repeated every 5 to 30 minutes to relieve symptoms and maintain the patient's comfort, with careful blood pressure monitoring 1.
• However, the use of morphine should not preclude the use of other anti-ischemic therapies with proven benefits, and its potential for adverse events, such as respiratory depression and hypotension, should be carefully considered 1.

Administration and Monitoring

• Morphine should be administered intravenously, with a typical dose of 1 to 5 mg, and repeated as needed to relieve symptoms and maintain patient comfort 1.
• Patients should be closely monitored for side effects, including respiratory depression, hypotension, nausea, and vomiting, and naloxone should be readily available to reverse severe respiratory depression if needed 1.
• The use of morphine should be cautious in patients with respiratory conditions, and alternative therapies should be considered if necessary 1.

From the FDA Drug Label

While low doses of intravenously administered morphine have little effect on cardiovascular stability, high doses are excitatory, resulting from sympathetic hyperactivity and increase in circulatory catecholamines

Morphine may be given to a cardiac patient because low doses of intravenously administered morphine have little effect on cardiovascular stability. However, it is crucial to use morphine with caution in cardiac patients, as high doses can be excitatory and lead to increased circulatory catecholamines, which may negatively impact cardiovascular stability 2.

From the Research

Morphine Administration in Cardiac Patients

Morphine is given to cardiac patients for several reasons, including:

• Relief of chest pain associated with acute coronary syndrome (ACS) 3, 4, 5
• Reduction of sympathetic stress and catecholamine release, which is an important therapeutic goal in the treatment of ACS 6
• Analgesic effects, which can help reduce the patient's discomfort and anxiety 5, 6

Benefits and Risks of Morphine Use

The use of morphine in cardiac patients has both benefits and risks, including:

• Benefits: rapid and significant decrease in pain intensity, relief of chest pain, and reduction of sympathetic stress and catecholamine release 5, 6
• Risks: higher mortality, increase in the size of the infarct, and potential for adverse events such as hypotension 7, 6

Comparison with Other Analgesics

Morphine has been compared to other analgesics, such as fentanyl, in the treatment of ischemic-type chest pain, with studies showing that:

• Fentanyl and morphine are comparable in providing analgesia for ischemic-type chest pain 6
• Fentanyl appears to be a safe and effective alternative to morphine for the management of chest pain in the prehospital setting 6

Clinical Guidelines and Recommendations

Clinical guidelines and recommendations for the use of morphine in cardiac patients vary, with some studies suggesting that:

• Morphine is recommended for the management of chest pain in ACS, but its benefits and risks should be carefully considered 3, 4
• The use of morphine and other analgesics should be tailored to the individual patient's needs and medical history 5, 6