AN EVIDENCE BASED APPROACH TO THE INITAL MANAGEMENT OF ST-ELEVATED MYOCARDIAL INFARCTION: WHY “MONA” IS NO LONGER A RELEVANT LEARNING TOOL FOR PHYSICIAN ASSISTANTS

Abstract

Introduction: Morphine, oxygen, nitrates and aspirin (MONA) have been used in the management of ST-elevated myocardial infarctions (STEMI) for over 40 years, despite the advancements in treatment. This literature review explores evidence-based research regarding the benefits and pitfalls of ‘MONA’ treatments in acute STEMI patients. Methods: A qualitative literature review was performed looking at the recommendations and evidence surrounding the medical management of STEMI patients in the first two hours of diagnosis and within adequate travel times for percutaneous intervention. Results: Morphine should not be used routinely in acute STEMI, but rather solely considered in the event of severe ischemic pain not relieved by other therapies. Due to the risks of hyperoxygenation on hemodynamics, supplemental oxygen is only beneficial in hypoxemic patients with an SpO2<90%. The limited evidence surrounding the use of nitroglycerin in acute STEMI is inconclusive to its benefit on mortality. Routine use of aspirin is recommended as soon as possible after the ischemic event. Conclusion: The mnemonic MONA is not sufficient for understanding the proper acute management of STEMI patients. Care must be made to individualize treatments to each patient’s condition while also considering contraindications to therapy.