In suspected myocardial infarction in the dental setting, what is the recommended first-line pharmacological action?

• A. Administer aspirin 300 mg chewed, if not contraindicated (no true allergy or active GI bleeding); arrange urgent transfer to hospital; if nitroglycerin is prescribed, give as directed and monitor blood pressure.
• B. Give oxygen only.
• C. Administer morphine sulfate for chest pain.
• D. Give sublingual nitro spray only.

Answer: (A)

In suspected myocardial infarction, the most important immediate pharmacological action is to give a fast-acting antiplatelet dose of aspirin. Chewing 300 mg of aspirin speeds absorption through the mouth and rapidly inhibits platelet aggregation, helping to prevent further thrombus growth and reduce mortality in the critical early hours. This should be done promptly unless there is a clear contraindication, such as an allergy to aspirin or active gastrointestinal bleeding. After giving aspirin, arrange urgent transfer to hospital so definitive treatment can begin. If the patient has nitroglycerin prescribed, administer it as directed and monitor blood pressure, since nitrates can cause hypotension and interact with other medications. Oxygen is appropriate only if the patient is hypoxic or in distress, not as a blanket first-line action, and therapies like morphine or a sublingual nitro spray alone do not address the key issue of platelet aggregation and are not the primary initial step.