GP or A E

1
Chest Pain Patient Pathway June 2006
Patient Presentation
GP or AE
Recent onset or change in character of chest pain
or discomfort, possibly of cardiac origin
Initial assessment
Do you suspect acute coronary syndrome
(myocardial infarction or unstable angina)?
Gilbert Bain AE
Yes
Immediate admission Thrombolysis pathway
No
GP

• Consider secondary causes perform routine
  clinical examination (exclude murmurs)
• Risk assessment
• Take blood (for FBC, lipid profile, blood sugar,
  TFTs, UEs, LFTs)
• Ideally perform 12 lead ECG

Assess 6 chest pain criteria 1. Precipitation by
exercise 2. Brief duration 3. Prompt relief by
rest or GTN 4. Substernal location 5. Radiation
from chest to jaw, left arm or neck 6. Absence of
other causes of pain
Criteria 1-3 positive, or any four criteria
positive Highly likely to be angina
Any two criteria positive, or only criteria 4-6
positive Possibly angina
Only one criterion positive Unlikely to be
angina

• Known angina with gradual deterioration despite
  treatment.
• Difficulties tolerating angina treatment.
• Patient likely to need consultant review.
• Consider, aspirin, atenolol, statin

Acute or recent onset Unable to do normal
life activities
High index of suspicion eg patient with multiple
risk factors (or diabetes alone) with other non
specific cardiac symptoms
Low index of suspicion
GP
Appropriate management
Persistent symptoms
Medical Outpatients
Rapid Access Chest Pain Clinic
Medical Outpatients
Refer to be seen within at next available
appointment (approx within 14 days)
Early referral
Routine referral
Patient
Secondary Care
Primary Care
Based on www.cci.scot.nhs.uk