For a patient with chest pain suggestive of ACS, what single medication should be given if no contraindication?

• A. Aspirin, 160–325 mg chewable
• B. Nitroglycerin spray
• C. Morphine
• D. Intravenous fluids

Answer: (C)

In suspected ACS, the most important single medicine to give immediately is a mast antiplatelet that blocks further clot formation. Aspirin is used right away because it irreversibly inhibits platelet COX-1, which reduces thromboxane A2 and prevents ongoing platelet aggregation. This early, rapid action has been shown to improve outcomes and reduce mortality in ACS. The recommended approach is a chewable dose of about 160–325 mg so it enters the bloodstream quickly through the oral mucosa.

If there’s a contraindication to aspirin (such as an allergy, active major GI bleed, or certain bleeding disorders), alternatives exist, but absent those contraindications aspirin remains the best first choice.

Other options like nitroglycerin can help relieve chest pain and may be used if there’s no hypotension or other contraindications, and morphine is generally reserved for pain control if analgesia is not achieved with nitrates. Intravenous fluids are not a single ACS-targeted treatment and are given based on the patient’s volume status and blood pressure.

So, the best single medication to give first, when there’s no contraindication, is aspirin for its proven mortality benefit and rapid onset of action.