Introduction to chest pain

Chest pain is another common presentation in the ED.

There are several different causes and it is important to differentiate the sinister from the benign.

Recent audits have shown that there was an overtreatment of patients with chest pain, leading to an increase in adverse events such as intracranial bleeds.

The chest pain guidelines are meant to help identify patients who require full ACS treatment, however there is a lot to read over.

It is often easy when the patient has a clear cut diagnosis of NSTEMI or STEMI. However, the unclear ones are much more difficult to manage. Some of the key take away points are:

1) There are several non-MI causes of troponin rise, if it doesn't sound like ACS caution full treatment.

2) Be careful about giving full ACS treatment in Head Injury or Collapse - they are at increased risk of intracranial bleed following treatment. Discuss these patients with an ED senior to consider CT head pre-anticoagulation.

3) Be sure to ask about increasing frequency of angina symptoms - crescendo angina requires admission and isn't covered within the guidelines.

4) 1st Trop should be taken at least 2 hours after onset of pain (where there is a clear approximate time of onset).

5) Patients who have an initial intermediate Trop result will need a repeat done that is at least 3 hours after the first Trop.

6) If you are happy that the patient can go home, but they do have angina like symptoms - complete a Rapid Access Chest Pain (RACP) clinic referral form. These can be taken to placed in the clinical notes and will be scanned by reception before being emailed to the cardiology team.