CHEST PAIN ASSESSMENT - CLINICAL PATHWAY

see Acute ST-Elevation Myocardial infarction (STEMI)

Introduction

  • ECG should be obtained < 10min of presentation (and reviewed by registrar/consultant)
  • Any patient with unrelieved chest pain or ST/T changes on ECG require urgent assessment (triage category 2)
  • Relieved chest pain WITH normal ECG may have deferred assessment

Assessment

Ask four questions:

Is the patient severely unwell? (Hypoxic or hypotensive?)

Is this an acute ST-elevation MI and candidate for reperfusion therapy?

Is it likely that this is Angina? (see Risk stratification of angina)

    Are there additional worrying features? (see High risk angina/NSTEMI)

Have you considered other important causes of chest pain (e.g. PE, Aortic dissection, Acute pericarditis)?

See Causes of chest pain

See Causes of pleuritic chest pain