Excerpt

Chest pain or discomfort caused by acute coronary syndromes (ACS) or angina has a potentially poor prognosis, emphasising the importance of prompt and accurate diagnosis. Treatments are available to improve symptoms and prolong life, hence the need for this guideline.

This guideline covers the assessment and diagnosis of people with recent onset chest pain or discomfort of suspected cardiac origin. In deciding whether chest pain may be cardiac and therefore whether this guideline is relevant, a number of factors should be taken into account. These include the person's history of chest pain, their cardiovascular risk factors, history of ischaemic heart disease and any previous treatment, and previous investigations for chest pain.

For pain that is suspected to be cardiac, there are two separate diagnostic pathways presented in the guideline. The first is for people with acute chest pain in whom ACS is suspected, and the second is for people with intermittent stable chest pain in whom stable angina is suspected. The guideline includes how to determine whether myocardial ischaemia is the cause of the chest pain and how to manage the chest pain while people are being assessed and investigated.

The diagnosis and management of chest pain that is clearly unrelated to the heart (e.g. traumatic chest wall injury, herpes zoster infection) is not considered once myocardial ischaemia has been excluded. The guideline makes no assumptions about who the patient consults, where that consultation takes place (primary care, secondary care, emergency department) or what diagnostic facilities might be available. It recognizes that while atherosclerotic CAD is the usual cause of angina and ACS, it is not a necessary requirement for either diagnosis. Similarly, it recognises that in patients with a prior diagnosis of CAD, chest pain or discomfort is not necessarily cardiac in origin.

Contents

• Key Priorities for Implementation
• All Recommendations
• Acute Chest Pain Care Pathway
• Stable Chest Pain Care Pathway
• 1. Introduction Chapter
  • 1.1. Epidemiology
  • 1.2. Aim of the guideline
  • 1.3. Approach
  • 1.4. Diagnostic pathway
  • 1.5. How the guideline is set out
  • 1.6. Scope
  • 1.7. Responsibility and support for guideline development
• 2. Methods Chapter
  • 2.1. Introduction
  • 2.2. Developing key clinical questions (KCQs)
  • 2.3. Literature search strategy
  • 2.4. Identifying the evidence
  • 2.5. Critical appraisal of the evidence
  • 2.6. Health Economics
  • 2.7. Assigning levels to the evidence
  • 2.8. Forming recommendations
  • 2.9. Areas without evidence and consensus methodology
  • 2.10. Consultation
  • 2.11. Relationships between the guideline and other national guidance
  • 2.12. Research Recommendations
  • 2.13. Acknowledgements
  • 2.14. Definitions, Glossary and Abbreviations
• 3. Information for Patients Chapter
  • 3.1.1. Introduction
  • 3.1.2. Evidence statements
  • 3.1.3. Evidence
  • 3.1.4. Evidence to recommendations
• 4. People Presenting with Acute Chest Pain Chapter
  • 4.1. Introduction
  • 4.2. Assessment
  • 4.3. Early Management
  • 4.4. Investigations and Diagnosis
• 5. People presenting with Stable Chest Pain
  • 5.1. Assessment
  • 5.2. Investigations and diagnosis of patients with stable chest pain suspected to be stable angina
• Reference List
• Appendices
  • Appendix A. Scope
  • Appendix B. Declarations of Interest
  • Appendix C1. Clinical questions
  • Appendix C2. Search Strategies
  • Appendix D. Clinical evidence extractions
  • Appendix E. Health economic extractions
  • Appendix F. Health economic modelling

Suggested citation:

Cooper A, Calvert N, Skinner J, Sawyer L, Sparrow, K, Timmis A, Turnbull N, Cotterell M, Hill D, Adams P, Ashcroft J, Clark L, Coulden R, Hemingway H, James C, Jarman H, Kendall J, Lewis P, Patel K, Smeeth L, Taylor J. (2010) Chest pain of recent onset: Assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin London: National Clinical Guideline Centre for Acute and Chronic Conditions