For acetaminophen and ibuprofen, suspected ischemic chest pain is listed as a contraindication. Is this listed mainly to indicate that ischemic chest pain should not be treated with the analgesia directive? Could analgesics be administered to treat a different area of pain that is occurring at the same time as the chest pain that appears to be unrelated? For example, I had a patient with chronic pain that she takes acetaminophen for, but she was experiencing acute chest pain suspected to be ischemic. Would it be correct to withhold acetaminophen in this case and not provide treatment for the chronic pain that she is experiencing at the same time as suspected cardiac ischemia?

You are correct in identifying that the contraindication exists so that ischemic chest pain is not treated with the analgesia directive. If a patient, as you describe, requires analgesia for a reason in addition to the suspected cardiac ischemia, they can receive both acetaminophen and treatment for the suspected cardiac ischemia. Just make sure to document the rationale for this treatment on your ACR, so the reasoning is followed. In this specific clinical scenario presented, NSAIDs should be avoided. 

Analgesia,Cardiac Ischemia,Cardiac/Circulation,Pain/Sedation/Nausea

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