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= Paid-up subscribersCardiovascular medicine:Chest pain of recent onset requires prompt diagnosis
23 Jun 2010
The new NICE guidance on recent onset chest pain urges GPs to assess the nature and timing of acute pain rapidly and arrange urgent admission for suspected acute coronary syndrome (ACS). Key features of the presenting history are: pain in the chest and/or other areas (e.g. the arms, back or jaw) lasting longer than 15 minutes; chest pain associated with nausea and vomiting, marked sweating breathlessness, or a combination of these; chest pain associated with haemodynamic 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 longer than 15 minutes. If any, or all, of these features are present ACS should be suspected. A 12-lead ECG should be performed and treatment commenced with 300 mg aspirin and GTN spray. Other pain relief such as opiates should be considered. The routine use of oxygen is not advised unless supported by pulse oximetric evidence of desaturation (<94% in those not at risk of hypercapnic respiratory failure).
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