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12 - 72 hours post Chest Pain

NICE CKS guidance

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

  • For men ≥40 years: New S–T elevation 2 mm or greater in V2-V3

  • For Men <40 years: New S-T elevation 2.5mm or greater in V2-V3

  • For Women (any age): New S-T elevation 1.5mm or greater in V2-V3

  • OR (for any gender any age): New S-T elevation 1mm or greater in any other two contiguous leads, ie V1-V2, V3-V6, I, II, III, AVR, AVL, AVF

  • New left bundle branch block (LBBB)

  • Widespread S–T depression

  • New left bundle branch block (LBBB). NB in primary care it can be difficult to assess whether changes are new or not, and emergency assessment is usually necessary if patient is symptomatic.

  • New T wave inversion especially in leads V2, V3, and V4 (1)


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 CRCH 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 use MAXIMs chest pain referral process

1. ESC 4th Universal Definition of MI (2018)

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