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Diamorphine or morphine for ischaemic cardiac chest pain
  1. Steve Halford, Specialist Registrar,
  2. H Simpson, Consultant
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}


    A short cut review was carried out to establish whether morphine is better than diamorphine at allieviating chest pain after an acute myocardial infarction. Altogether 66 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

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    Report by Steve Halford,Specialist RegistrarChecked by H Simpson,Consultant

    Clinical scenario

    A 55 year old man presents to the emergency department with chest pain. An ECG shows changes consistent with acute myocardial infarction. He is given aspirin and oxygen. His thrombolytic therapy is started and in the meantime you wonder whether his pain would be best alleviated by either morphine or diamorphine.

    Three part question

    In [patients with a myocardial infarction] is [morphine better than diamorphine] at [alleviating chest pain]?

    Search strategy

    Medline 1966–02/03 using the OVID interface. [(exp chest pain OR exp myocardial infarction OR myocard$.mp OR infarct$.mp OR AND (exp morphine OR OR OR OR analg$.mp OR exp analgesics, opioid) AND (exp clinical trials OR exp randomized controlled trials OR randomized controlled] LIMIT to human AND English.

    Search outcome

    Altogether 66 papers were identified of which only one was relevant. Details of this paper are shown in table 1.

    Table 1


    This is the only paper identified that compares morphine and diamorphine in this clinical situation. The doses were fixed.

    Clinical bottom line

    There are no significant clinical differences between diamorphine and morphine in patients with chest pain.

    Report by Steve Halford,Specialist RegistrarChecked by H Simpson,Consultant


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