12 - 72 hours post Chest Pain

NICE CKS guidance

Please perform an ECG - consider admitting via 999 ambulance if this shows:

  • ST elevation in two or more contiguous leads of >2mm in chest leads or >1mm in limb leads

  • or new Left Bundle Branch Block


If the patient is reviewed 12 - 72 hours after chest pain and the patient is haemodynamically stable, please discuss with acute GP service, where we can see in clinic and consider troponin testing as per the RCHT ACS pathway.


If you have performed a troponin in the community and it is positive, this may warrant an admission to medicine on ACS protocol. Please discuss with the Cardiologist of the Week (CoW) or the Acute GP service.


Patients with a negative troponin at least 12 hours post cardiac-sounding chest pain may be appropriate for the urgent chest pain pathway. Please find the outpatient rapid access chest pain referral form below. If not fulfilling referral criteria on the form, please consider alternative diagnoses or referral for routine outpatient cardiology review.




Outpatient Chest Pain referral form



For inpatient use, please find the Inpatient Urgent Chest Pain referral form: