NICE guidelines for the management of patients with acute chest pain: Difference between revisions
Line 44: | Line 44: | ||
* 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. | ||
Resting 12-Lead ECG | ===Resting 12-Lead ECG=== | ||
Take a resting 12-lead ECG as soon as possible. When people are referred, send the results to hospital before they arrive if possible. Recording and sending the ECG should not delay transfer to hospital. | * Take a resting 12-lead ECG as soon as possible. | ||
Follow local protocols for people with a resting 12-lead ECG showing regional ST-segment elevation or presumed new left bundle branch block (LBBB) consistent with an acute STEMI until a firm diagnosis is made. Continue to monitor. | * When people are referred, send the results to hospital before they arrive if possible. | ||
Follow Unstable angina and NSTEMI | * Recording and sending the ECG should not delay transfer to hospital. | ||
Even in the absence of ST-segment changes, have an increased suspicion of an ACS if there are other changes in the resting 12-lead ECG, specifically Q waves and T wave changes. Consider following Unstable angina and NSTEMI | * Follow local protocols for people with a resting 12-lead ECG showing regional ST-segment elevation or presumed new left bundle branch block (LBBB) consistent with an acute STEMI until a firm diagnosis is made. Continue to monitor. | ||
Do not exclude an ACS when people have a normal resting 12-lead ECG. | * Follow Unstable angina and NSTEMI for people with a resting 12-lead ECG showing regional ST-segment depression or deep T wave inversion suggestive of a NSTEMI or unstable angina until a firm diagnosis is made. Continue to monitor. | ||
If a diagnosis of ACS is in doubt, consider: | * Even in the absence of ST-segment changes, have an increased suspicion of an ACS if there are other changes in the resting 12-lead ECG, specifically Q waves and T wave changes. Consider following Unstable angina and NSTEMI if these conditions are likely. Continue to monitor. | ||
Taking serial resting 12-lead ECGs | * Do not exclude an ACS when people have a normal resting 12-lead ECG. | ||
Reviewing previous resting 12-lead ECGs | * If a diagnosis of ACS is in doubt, consider: | ||
Recording additional ECG leads | ** Taking serial resting 12-lead ECGs | ||
** Reviewing previous resting 12-lead ECGs | |||
Use clinical judgment to decide how often this should be done. Note that the results may not be conclusive. | ** Recording additional ECG leads | ||
* Use clinical judgment to decide how often this should be done. Note that the results may not be conclusive. | |||
Obtain a review of resting 12-lead ECGs by a healthcare professional qualified to interpret them as well as taking into account automated interpretation. | * Obtain a review of resting 12-lead ECGs by a healthcare professional qualified to interpret them as well as taking into account automated interpretation. | ||
If clinical assessment and a resting 12-lead ECG make a diagnosis of ACS less likely, consider other acute conditions. First consider those that are life threatening such as pulmonary embolism, aortic dissection or pneumonia. Continue to monitor. | * If clinical assessment and a resting 12-lead ECG make a diagnosis of ACS less likely, consider other acute conditions. First consider those that are life threatening such as pulmonary embolism, aortic dissection or pneumonia. Continue to monitor. | ||
}} | }} | ||
Revision as of 16:51, 9 May 2012
Chest pain Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
NICE guidelines for the management of patients with acute chest pain On the Web |
FDA on NICE guidelines for the management of patients with acute chest pain |
CDC on NICE guidelines for the management of patients with acute chest pain |
NICE guidelines for the management of patients with acute chest pain in the news |
Blogs on NICE guidelines for the management of patients with acute chest pain |
to Hospitals Treating NICE guidelines for the management of patients with acute 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
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]
“ |
Initial Assessment and Referral to Hospital
Resting 12-Lead ECG
|
” |