Incorporating: Acute GP, SDEC, UTC
Chest Pain (cardiac-sounding*)
STEP 1: Please assess patient for observations, salient history and ECG
​
STEP 2: Do they have any:
​
-
Ongoing cardiac-sounding chest pain (despite simple measures such as 2 puffs s/l GTN)
-
ST elevation criteria (see below) or new LBBB on ECG
-
Haemodynamically instability?
​​
Not sure? Please call the Acute GP service to discuss.
ECG criteria for STEMI:
New ST-segment elevation >1mm in two contiguous leads, in all leads except V2 and V3.
In leads V2 and V3, the threshold is:
-
>2mm for men >40, or > 2.5mm for men < 40,
-
>1.5mm for women
-OR-
-
New LBBB
Source: American College of Cardiology (ACC), American Heart Association (AHA), ESC, and the World Heart Federation (WHF)
*cardiac sounding chest pain can involve any of the following (LR+):
-
​Experienced clinical gestalt suggesting cardiac origin (LR+ 4.7 (95% CI: 2.5–8.9))
-
Chest (or posterior thoracic) pain
-
Typically 'pressure' or tightness in character (LR+ 1.3 (95% CI: 1.2–1.5))
-
Radiating to either arm (LR+ 2.3 (95% CI: 1.7–3.1))
-
Associated autonomic symptoms (eg sweating) (LR+ 2.0 (95% CI: 1.9–2.2))
-
Absence of chest wall tenderness (LR+ 2.1 (95% CI: 1.6–2.8))
​
​
CIoS Intermediate Care Chest Pain guidelines are based upon recommendations from NICE CG95's CAD background risks, CG185, NEJM's SENIOR-RITA data and in partnership with RCH Cardiology
​
LR Reference
McConaghy, J.R. & Oza, R.S. (2013) ‘Outpatient Diagnosis of Acute Chest Pain in Adults’, JAMA Rational Clinical Examination Series, 309(21), pp. 2213–2222. Available at: https://jamanetwork.com/journals/jama/fullarticle/1697967 (Accessed: 25 February 2025)