Chest pain

All patients presenting with suspected ischaemic chest pain should have a clinical assessment, examination, PMHx and risk factor profile.

Initial investigations include:

• FBC
• U&E, LFT, TFT, Lipids
• HbA1c
• ECG

If referring for consideration of angina diagnosis:

• Provide the person with sublingual glyceryl trinitrate to use for the relief of symptoms while they are waiting for specialist assessment.
  • Instruct the person that if they experience chest pain they should:
    • Stop what they are doing and rest.
    • Use their glyceryl trinitrate spray or tablets as instructed.
    • Take a second dose after 5 minutes if the pain has not eased.
    • Call 999 for an ambulance if the pain has not eased 5 minutes after the second dose, or earlier if the pain is intensifying or the person is unwell.
• Consider prescribing aspirin (75 mg daily) until the diagnosis is confirmed if chest pain is considered likely to be stable angina.
• Manage cardiovascular risk factors

Refer to Rapid Access Chest Pain Clinic

• Age > 30 with no previous cardiac history
• Pain is typical (tight or constricting across the chest, jaw, neck, shoulder or arms lasting < 20 minutes
• Precipitated by physical exertion or psychological stress
• Relieved by rest or GTN
• Symptoms of recent onset (within past year)
• BP within 180/90 (if not treat and reassess)

Referrals are made via SCI-Gateway...DGRI...Cardiology...RACPS.

All referrals are trated as urgent.

Refer to cardiology

The following are not suitable for the rapid access chest pain clinic but should be referred to cardiology instead. Referrals to cardiology are traiged daily by a consultant. If concerned contact on call cardiologist for advice or named consultant secretary.

• Isolated episode of chest pain lasting less than 20 minutes
• Symptoms for over 1 year
• Complex history of ischemic heart disease, recent MI, or under current cardiology review
• Normal cardiac investigations in the past 5 years
• Symptoms driven by shortness of breath, dizziness, or palpitation
• New murmur, arrhythmia, or heart failure

Referrals are made via SCI-Gateway...DGRI...Cardiology...General Referral

If you are unsure and would like to discuss the referral before submitting , the Cardiology Specialty Clinical Lead/ Carsdiology Nurse Specialist can be contacted: Monday to Friday 01387 241149. Or advice is available via SCI Gateway advice request.

The following are unlikely to be cardiac. Chest pain and other causes should be ruled out in the first instance:

• Pain is sharp, localized, or pleuritic.
• Pain is constant or clearly reproduced on palpation.
• Pyrexia, cough, or sputum is present.
• Predominantly at rest or at night.
• Clear symptoms of reflux