Hospital management of acute chest pain of possible cardiac origin

Chew, 2016 National Institute for Health and Clinical Excellence (NICE), 2010 [updated 2016]

When arranging transfer to hospital for a patient with acute chest pain of possible cardiac origin, ensure the patient has with them a record of:

• therapy that has already been given
• whether an intravenous line has been inserted
• whether a 12-lead electrocardiogram (ECG) or monitoring strip is available
• whether chest pain is ongoing
• whether they have an advance care plan.

Consider starting or continuing initial therapy for acute chest pain of possible cardiac origin when the patient arrives at hospital.

All patients presenting with undifferentiated chest pain should have a 12-lead ECG within 10 minutes of arrivalAustralian Commission on Safety and Quality in Health Care (ACSQHC), 2019. The ECG should be read by a clinician experienced in reading ECGs. If there is ongoing pain or the ECG results are unclear, repeat the ECG every 10 to 15 minutes.

Management depends on whether clinical assessment indicates cardiac or noncardiac pain. Care should be guided by the hospital’s assessment protocol for suspected acute coronary syndrome¹, as specified in the Australian Commission on Safety and Quality in Health Care (ACSQHC) Acute Coronary Syndromes Clinical Care StandardAustralian Commission on Safety and Quality in Health Care (ACSQHC), 2019.

If a cardiac cause of chest pain is suspected, the assessment protocol for suspected acute coronary syndrome is used to guide classification into:

• ST elevation myocardial infarction (STEMI)
• non–ST elevation myocardial infarction (NSTEMI)
• unstable angina
• stable angina
• chest pain that is unlikely to be an acute coronary syndrome.

STEMI is a ‘time to reperfusion’ critical emergency.

See Acute coronary syndromes and Stable angina for management detail.