NICE guidelines for management of chest pain: Difference between revisions
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==NICE Guidelines for the Management of Patients with Chest Pain<ref name="pmid30533431">{{cite journal |vauthors=Carrabba N, Migliorini A, Pradella S, Acquafresca M, Guglielmo M, Baggiano A, Moscogiuri G, Valenti R |title=Old and New NICE Guidelines for the Evaluation of New Onset Stable Chest Pain: A Real World Perspective |journal=Biomed Res Int |volume=2018 |issue= |pages=3762305 |date=2018 |pmid=30533431 |pmc=6250018 |doi=10.1155/2018/3762305 |url=}}</ref> == | ==NICE Guidelines for the Management of Patients with Chest Pain<ref name="pmid30533431">{{cite journal |vauthors=Carrabba N, Migliorini A, Pradella S, Acquafresca M, Guglielmo M, Baggiano A, Moscogiuri G, Valenti R |title=Old and New NICE Guidelines for the Evaluation of New Onset Stable Chest Pain: A Real World Perspective |journal=Biomed Res Int |volume=2018 |issue= |pages=3762305 |date=2018 |pmid=30533431 |pmc=6250018 |doi=10.1155/2018/3762305 |url=}}</ref> == | ||
::* Symptoms suggestive od [[acute coronary syndromes]]: | ::* Symptoms suggestive od [[acute coronary syndromes]]: | ||
*Pain in the [[chest]] and/or other areas (for example, the [[arms]], [[back]] or [[jaw]]) lasting longer than 15 minutes · | *Pain in the [[chest]] and/or other areas (for example, the [[arms]], [[back]] or [[jaw]]) lasting longer than 15 minutes · | ||
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* Checking [[oxygen saturation]] and administer [[oxygen]] if appropriate | * Checking [[oxygen saturation]] and administer [[oxygen]] if appropriate | ||
* Monitoring the [[patient]] | * Monitoring the [[patient]] | ||
==NICE Guidelines for the Management of Patients with Acute Chest Pain <ref name="pmid30533431">{{cite journal |vauthors=Carrabba N, Migliorini A, Pradella S, Acquafresca M, Guglielmo M, Baggiano A, Moscogiuri G, Valenti R |title=Old and New NICE Guidelines for the Evaluation of New Onset Stable Chest Pain: A Real World Perspective |journal=Biomed Res Int |volume=2018 |issue= |pages=3762305 |date=2018 |pmid=30533431 |pmc=6250018 |doi=10.1155/2018/3762305 |url=}}</ref>== | ==NICE Guidelines for the Management of Patients with Acute Chest Pain <ref name="pmid30533431">{{cite journal |vauthors=Carrabba N, Migliorini A, Pradella S, Acquafresca M, Guglielmo M, Baggiano A, Moscogiuri G, Valenti R |title=Old and New NICE Guidelines for the Evaluation of New Onset Stable Chest Pain: A Real World Perspective |journal=Biomed Res Int |volume=2018 |issue= |pages=3762305 |date=2018 |pmid=30533431 |pmc=6250018 |doi=10.1155/2018/3762305 |url=}}</ref>== | ||
Revision as of 10:51, 14 January 2022
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Chest pain Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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NICE guidelines for management of chest pain On the Web |
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to Hospitals Treating NICE guidelines for management of chest pain |
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Risk calculators and risk factors for NICE guidelines for management of chest pain |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Priyamvada Singh, M.B.B.S. [3]
Overview
In the 2016 update of the stable chest pain guideline, National Institute for Health and Clinical Excellence (NICE) has dramatically changed its approach to new-onset stable chest pain aiming to find a more cost-effective strategy including NO use of pretest probability risk scores or NO use of functional tests, such as stress echocardiography, as a first-line investigation. The suggestion is to use CT coronary angiography in the majority of patients whether no diagnostic testing if chest pain is non-anginal and CT coronary angiography (CTCA) in patients with typical or atypical chest pain with additional perfusion imaging in the setting of uncertainty about the functional significance of coronary lesions. However, the recommendation of the European Society of Cardiology (ESC—2013) is functional tests as the initial investigation.
NICE Guidelines for the Management of Patients with Chest Pain[1]
- Symptoms suggestive od acute coronary syndromes:
- Pain in the chest and/or other areas (for example, the arms, back or jaw) lasting longer than 15 minutes ·
- Chest pain associated with nausea and vomiting, marked sweating, breathlessness, or particularly a combination of these ·
- Chest pain associated with hemodynamic instability ·
- New onset chest pain, or abrupt deterioration in previously stable angina, with recurrent chest pain occurring frequently and with little or no exertion, and with episodes often lasting longer than 15 minutes
- If the patient is currently pain-free, but had chest pain in the last 12 hours, and resting 12-lead ECG is abnormal or not available or develops further chest pain after recent (confirmed or suspected) ACS, the patient should be admitted in the hospital.
- Management of ACS:
- Transferring the patient to hospital immediately
- Taking a resting 12-lead ECG ·
- Managing pain with GTN and/or an opioid
- Giving a single dose of 300 mg aspirin unless the person is allergic, and other neccessary therapeutic interventions
- Checking oxygen saturation and administer oxygen if appropriate
- Monitoring the patient
NICE Guidelines for the Management of Patients with Acute Chest Pain [1]
Investigation and diagnosis of acute chest pain in hospital
Assessment of acute chest pain in hospital
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| Normal resting ECG or non-diagnostic | ECG changes consistent with NSTEMI | ECG changes consistent with STEMI | |||||||||||||||||||||||||||||||||||||||||||||||
| Low risk patient with undetectable hs-troponin level: Reassurance, discharge | Consider ACS by clinical judgment even in the presence of normal ECG
| NSTEMI, ACS Guideline follow-up | STEMI Guideline follow-up | ||||||||||||||||||||||||||||||||||||||||||||||
| hs-troponin concentration on arrival and at 3 hours bellow the cut-off measurement: Low risk patient, discharge | hs-troponin concentration on arrival and at 3 hours higher than cut-off measurement | Diagnostic criteria for MI | |||||||||||||||||||||||||||||||||||||||||||||||
| Yes: | NO:
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| The above algorithm adopted from 2016 NICE Guideline |
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NICE guidelines for the management of patients with stable chest pain[1]
National Institute for Health and Clinical Excellence (NICE) has dramatically changed its guideline on approach to stable chest pain aiming to find a more cost-effective strategy including NO use of pretest probability risk scores or NO use of functional tests, such as stress echocardiography, as a first-line investigation in patients with new-onset stable chest pain. The suggestion is to use CT coronary angiography in the majority of patients. However, the recommendation of the European Society of Cardiology (ESC—2013) is functional tests as the initial investigation.[2]
Assessment and detailed history
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| Non anginal aspect of chest pain without cardiac risk factors or clinical suspicious | Typical or atypical anginal in clinical assessment | ||||||||||||||||||||||||
Indentify other causes of chest pain
| Consider resting ECG
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| The above algorithm adopted from 2016 NICE Guideline |
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Consider 64 slice (or obove) Coronary CT Angiography in the presence of:
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Consider non-invasive functional imaging in the presence of:
| Consider stable angina in the presence of obstructive CAD on coronary CT angiography or reversible ischemia on functional imaging study
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Stable chest pain: ❑ Typical stable angina symptoms:
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Stable angina is unlikely if chest pain is: ❑ Not related to the activity | |||||||||||||||||||||||
ECG changes associated with CAD: ❑ LBBB
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Non-invasive functional imaging study for evaluation of myocardial ischemia: ❑Myocardial perfusion scintigraphy with single photon emission CT ( with adenosin, dipyridamole, dobutamine ❑ Stress echocardiography (with exercise or dobutamine ❑First pass contrast enhanced MR perfusion with adenosine or dipyridamole ❑ MR imaging with exercise or dobutamine | |||||||||||||||||||||||
Definition of significant CAD: ❑Coronary CT angiography:
❑ Factors associated with intensifying ischemia in the lesions less than 50%
❑ Factors associated reduced ischemia in significant lesion ≥70 %:
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| The above algorithm adopted from 2016 NICE Guideline |
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References
- ↑ 1.0 1.1 1.2 Carrabba N, Migliorini A, Pradella S, Acquafresca M, Guglielmo M, Baggiano A, Moscogiuri G, Valenti R (2018). "Old and New NICE Guidelines for the Evaluation of New Onset Stable Chest Pain: A Real World Perspective". Biomed Res Int. 2018: 3762305. doi:10.1155/2018/3762305. PMC 6250018. PMID 30533431.
- ↑ Timmis A, Roobottom CA (July 2017). "National Institute for Health and Care Excellence updates the stable chest pain guideline with radical changes to the diagnostic paradigm". Heart. 103 (13): 982–986. doi:10.1136/heartjnl-2015-308341. PMID 28446550.