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Quick reference guide


Issue date: March 2010

Chest pain of recent onset
Assessment and diagnosis of recent onset chest pain or
discomfort of suspected cardiac origin

This guideline partially updates NICE technology appraisal
guidance 73




NICE clinical guideline 95
Developed by the National Clinical Guideline Centre for Acute and Chronic…

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Chest pain of recent onset



About this booklet
This is a quick reference guide that summarises the recommendations NICE has made to the NHS in
`Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of
suspected cardiac origin' (NICE clinical guideline 95).
This guidance…

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Chest pain of recent onset Contents




Contents
Introduction 3

Person-centred care 3

Key to terms 4

Key priorities for implementation 4

People presenting with acute chest pain 6

People presenting with stable chest pain 10

Further information 15



Introduction
Fast and accurate diagnosis of chest pain or discomfort caused by…

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Chest pain of recent onset Key to terms




Key to terms
ACS: acute coronary syndrome MPS with SPECT: myocardial perfusion
CAD: coronary artery disease scintigraphy with single photon emission
computed tomography
CT: computed tomography
MR: magnetic resonance
ECG: electrocardiogram
NSTEMI: non-ST-segment-elevation myocardial
GTN: glyceryl trinitrate
infarction
LBBB: left bundle branch…

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Chest pain of recent onset Key priorities for implementation




G Unless clinical suspicion is raised based on other aspects of the history and risk factors,
exclude a diagnosis of stable angina if the pain is non-anginal (see recommendation 1.3.3.11).
Other features which make a diagnosis of stable angina unlikely are…

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People presenting with acute
Chest pain of recent onset chest pain




People presenting with acute chest pain
Check for a suspected ACS
G Check immediately if chest pain is current, or when the last episode was, particularly if in the last
12 hours.
G Check if the chest pain may…

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People presenting with acute
Chest pain of recent onset chest pain




Referral to hospital

ACS suspected?




Yes No

G Start management immediately (box 1) Consider other causes of chest
G Do not delay transfer to hospital pain, including potentially
life-threatening ones




G Current chest No current chest pain
pain or…

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People presenting with acute
Chest pain of recent onset chest pain




In hospital
Initial assessment (box 3)
ECG findings Troponin levels



G Regional ST-segment If initial troponin is
elevation or raised:
G Presumed new left G consider other causes
bundle branch block (LBBB)? e.g. myocarditis,
aortic dissection or
Yes No…

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People presenting with acute
Chest pain of recent onset chest pain




Box 2 Monitor until diagnosis
G Include:

­ exacerbations of pain and/or other symptoms
­ pulse and blood pressure
­ heart rhythm
­ oxygen saturation by pulse oximetry
­ repeated resting 12-lead ECGs
­ checking pain relief is effective.…

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People presenting with stable
Chest pain of recent onset chest pain




People presenting with stable chest pain
G Angina can be diagnosed based on clinical assessment alone or clinical assessment plus diagnostic testing.
G Manage risk factors for cardiovascular disease8 if chest pain is not stable angina.

Carry out a…

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