NICE guidelines for the management of patients with acute chest pain
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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
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. 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. Follow Unstable angina and NSTEMI (see the National Guideline Clearinghouse [NGC] summary of the NICE clinical guideline) 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. 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 (see the NGC summary of the NICE clinical guideline) if these conditions are likely. Continue to monitor. Do not exclude an ACS when people have a normal resting 12-lead ECG. If a diagnosis of ACS is in doubt, consider: Taking serial resting 12-lead ECGs Reviewing previous resting 12-lead ECGs 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. 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. |
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