NICE guidelines for the management of patients with acute chest pain: Difference between revisions
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* Use clinical judgment to decide whether referral should be as an emergency or urgent same-day assessment. | * Use clinical judgment to decide whether referral should be as an emergency or urgent same-day assessment. | ||
** If a recent ACS is suspected in people whose last episode of chest pain was more than 72 hours ago and who have no complications such as pulmonary oedema: | ** If a recent ACS is suspected in people whose last episode of chest pain was more than 72 hours ago and who have no complications such as pulmonary oedema: | ||
** Carry out a detailed clinical assessment | *** Carry out a detailed clinical assessment | ||
** Confirm the diagnosis by resting 12-lead ECG and blood troponin level | *** Confirm the diagnosis by resting 12-lead ECG and blood troponin level | ||
** Take into account the length of time since the suspected ACS when interpreting the troponin level. | *** Take into account the length of time since the suspected ACS when interpreting the troponin level. | ||
** Use clinical judgment to decide whether referral is necessary and how urgent this should be. | *** Use clinical judgment to decide whether referral is necessary and how urgent this should be. | ||
** Refer people to hospital as an emergency if they have a recent (confirmed or suspected) ACS and develop further chest pain. | *** Refer people to hospital as an emergency if they have a recent (confirmed or suspected) ACS and develop further chest pain. | ||
** When an ACS is suspected, start management immediately in the order appropriate to the circumstances and take a resting 12-lead ECG. Take the ECG as soon as possible, but do not delay transfer to hospital. | *** When an ACS is suspected, start management immediately in the order appropriate to the circumstances and take a resting 12-lead ECG. Take the ECG as soon as possible, but do not delay transfer to hospital. | ||
* If an ACS is not suspected, consider other causes of the chest pain, some of which may be life-threatening. | * If an ACS is not suspected, consider other causes of the chest pain, some of which may be life-threatening. | ||
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Revision as of 16:43, 9 May 2012
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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
The American College of Cardiology, American Heart Association,and National Institute for Health and Clinical Excellence (NICE) guidelines recommends performance of ECG for all patients with cardiac chest pain. Additionally, chest X-rays in patients with suspected congestive heart failure, aortic dissection, aortic aneurysm, valvular heart disease, pericardial disease. However, the guidelines recommend exercise testing in low and intermediate risk patients only after they have been screened for high risk features and other indications for hospital admission.
NICE guidelines for the management of patients with acute chest pain (DO NOT EDIT) [1]
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Initial Assessment and Referral to Hospital
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