Chest pain management: which medication should be given unless contraindicated?

• A. Ibuprofen
• B. Acetaminophen
• C. Morphine
• D. Aspirin

Answer: (D)

Prompt antiplatelet therapy is the key idea here. In suspected acute coronary syndrome, aspirin is given to inhibit platelet aggregation by irreversibly blocking COX-1 in platelets, which reduces thromboxane A2 and helps prevent clot growth. Starting aspirin early has been shown to lower mortality and improve outcomes, making it the priority unless there is a contraindication such as active bleeding, a known aspirin allergy, or a high bleeding risk.

Analgesics like ibuprofen or acetaminophen don’t address the clotting problem and don’t improve cardiovascular outcomes in this setting; ibuprofen may even interfere with aspirin’s antiplatelet effect if used together. Morphine can relieve pain but does not treat the underlying thrombosis and carries risks like respiratory depression and hypotension, so it isn’t the first-line therapy for suspected ACS.