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Acute chest pain

ACS – acute coronary syndrome covers a range of 
conditions as
 unstable angina ST-segment elevation MI ( STEMI ) Non-ST segment elevation MI ( NSTEMI )

Features suggesting ACS-pain in chest & or other areas ( arms ,back or jaw ) lasting longer than 15 mins chest pain associated with 
○ nausea and vomiting
○ marked sweating
○ breathlessness
or particularly a combination of these chest pain with HD instability new onset chest pain or
abrupt deterioration in previously stable angina with recurrent chest pain occurring frequently and with little or no exertion and with episodes often lasting > than 15 mins

Take into account-characteristic of pain history of chest pain any CV risk factors h/o IHD and any previous treatment previous investigation for chest pain

ACS suspected- immediate management pain relief ( GTN or an IV opioid ) 300 mg aspirin ( r/o allergy )
give written info to hospital if given
Do not offer other antiplatelets if allergy to aspirin in primary care resting 12-lead ECG pulse oximetry
Only offer oxygen if level < 94 % with no risk of hypercapnic resp failure
aim for 94-98 %
For COPD patients aim for 88-92 %

Check –haemodynamic status signs of complications like
○ pul oedema
○ cardiogenic shock signs of non-coronary causes of chest pain eg
aortic dissection

Monitor-exacerbation of pain and / or other symptoms pulse , bp heart rhythm oxygen saturation repeated 12 lead ECGs checking if pain relief effective

Chest pain or discomfort caused by ACS has
 a potentially poor prognosis- hence the guideline suggests referral to facilitate prompt and accurate diagnosis in all suspected ACS cases

References Chest pain of recent onset Quick reference guide NICE March 2010 Chest pain of recent onset : assessment and diagnosis NICE clinical guideline 95 March 2010 Chest Pain of Recent Onset : Assessment and Diagnosis of Recent Onset Chest Pain or Discomfort of Suspected Cardiac Origin London Royal College of Physicians NICE pathways Assessment and immediate management of suspected acute coronary syndrome


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