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<12hrs post chest pain


If haemodynamically unstable, these patients may require a '999' ambulance.


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). NB in primary care it can be difficult to assess whether changes are new or not, and emergency assessment is usually necessary if the patient is symptomatic.

  • Widespread S–T depression

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


If haemodynamically stable with none of the above ECG changes, please discuss these patients with the Acute GP service.


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




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