NSAIDS increase risk of Heart Attacks

A cohort of 446 763 individuals including 61 460 with acute myocardial infarction was acquired. Taking any dose of NSAIDs for one week, one month or more than a month was associated with an increased risk of myocardial infarction. With use for one to seven days, the probability of increased myocardial infarction risk (posterior probability of odds ratio >1.0) was 92% for celecoxib, 97% for ibuprofen, and 99% for diclofenac, naproxen, and rofecoxib. The corresponding odds ratios (95% credible intervals) were 1.24 (0.91 to 1.82) for celecoxib, 1.48 (1.00 to 2.26) for ibuprofen, 1.50 (1.06 to 2.04) for diclofenac, 1.53 (1.07 to 2.33) for naproxen, and 1.58 (1.07 to 2.17) for rofecoxib. Greater risk of myocardial infarction was documented for the higher dose of NSAIDs. With use for longer than one month, risks did not appear to exceed those associated with shorter durations.

STEMI Equivalents

  • Isolated Posterior Myocardial Infarction.
  • Isolated ST-Depression in AVL
  • Hyperacute T-waves (HATWs)
  • De Winter Pattern
  • ST Elevation (STE) in AVR
  • Presumed New Left Bundle Branch Block

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Chest Pain

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Clinical factors that INCREASE likelihood of ACS/AMI:

  • CP radiating bilaterally > right > left
  • Diaphoresis associated with CP
  • N/V associated with CP
  • Pain with exertion

Clinical factors that DECREASE likelihood of ACS/AMI:
Chest pain that is:

  • Pleuritic
  • Positional
  • Sharp, stabbing
  • Reproducible with palpation

A Woman’s Heart Attack

 

While men generally exhibit the typical symptoms of chest pressure and pain, women generally exhibit symptoms that are not well-known, leading them to delay seeking treatment. Women who are having a heart attack often feel pain in areas outside the chest, including the jaw, neck, abdomen, legs, and arms. Severe fatigue, sweating, or shortness of breath can also be present, leading women to feel as if they just ran a marathon even though they are standing still. Many women who have had heart attacks also mistake the chest pain for heartburn, indigestion, or a stomach ulcer.

How to identify that patient having a heart attack

Clinical factors that INCREASE likelihood of ACS/AMI:
  1. CP radiating bilaterally > right > left
  2. Diaphoresis associated with CP
  3. N/V associated with CP
  4. Pain with exertion

Clinical factors that DECREASE likelihood of ACS/AMI:
Chest pain that is:

  1. Pleuritic
  2. Positional
  3. Sharp, stabbing
  4. Reproducible with palpation