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 - please attach to referral

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.
  • If symptoms persist after 5 minutes use their glyceryl trinitrate as instructed.
  • Take a second dose after 5 minutes if the pain has not eased.
  • Call 999 for an ambulance if the pain persists, or earlier if the pain is intensifying and the person feels unwell.
• Consider prescribing aspirin (75 mg daily), Atorvastatin 80mg and other anti-anginal medication as appropriate until the diagnosis is confirmed.
• Manage cardiovascular risk factors, including lifestyle advice

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 treated as urgent.

Please DO not tell the patient they are attending for ETT. All patientss are seen, a full clinical history taken and any investigations required will be decided at the time of their appointment

Refer to cardiology

The following are not suitable for the rapid access chest pain clinic but should be referred to cardiology instead.

• History of ischemic heart disease, recent MI, or previous coronary intervention
• Normal cardiac investigations in the past 2 years
• Symptoms driven by shortness of breath, dizziness, or palpitation

Referrals to cardiology are triaged daily by a consultant cardiologist. If you have any urgent concerns you can contact the on call cardiologist via DGRI switchboard.

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

If you are unsure or need further guidance, the pathway is available at the start of the SCI gateway referral where you will also find contact details of the Specialist nurses who see patients in RACPC should you have an further questions

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.
• Clear symptoms of reflux
• Patients who present with a one off episode of chest discomfort