Podcast - NICE on Cardiac Chest Pain: A Quick Guide for Primary Care

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• NICE on Cardiac Chest ...
This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE.
My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode, I go through the NICE guideline on recent onset cardiac chest pain [CG95], always focusing on what is relevant in Primary Care only.
I am not giving medical advice; this episode is intended for health care professionals; it is only my summary and my interpretation of the guidelines and you must use your clinical judgement.
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Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis guideline [CG95] can be found here:
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Transcript
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Hello and welcome, I’m Fernando, a GP in the UK. Today we are going to go through the NICE guideline on recent onset cardiac chest pain [CG95], always focusing on what is relevant in Primary Care only.
Right, without any further ado, let’s jump into it.
We are going to start by looking at the assessment and diagnosis of recent acute chest pain, suspected to be an acute coronary syndrome. The term ACS covers a range of conditions including unstable angina, ST‑segment-elevation myocardial infarction (or STEMI) and non‑ST‑segment-elevation myocardial infarction (or NSTEMI).
We will not cover the management of these conditions, given that this would be done in the hospital setting.
The first obvious thing is to check whether the patient has chest pain at the time of the consultation.
If the patient is pain free, we will check when their last episode was, particularly if they have had pain in the last 12 hours. We will see the importance of this and the impact on the possible management later.
In order to decide whether the chest pain is cardiac we will consider:
· the history
· the presence of cardiovascular risk factors
· a history of ischaemic heart disease and
· any previous treatment and investigations for chest pain.
Symptoms suggestive of an ACS are:
· pain in the chest and/or, for example, arms, back or jaw, lasting longer than 15 minutes
· chest pain associated with nausea and vomiting, marked sweating, breathlessness, or particularly a combination of these
· chest pain associated with haemodynamic instability and
· new onset chest pain, or abrupt deterioration in previously stable angina, with frequent and recurrent chest pain on little or no exertion, and with episodes often lasting longer than 15 minutes.
· But we will bear in mind that not all people with an ACS present with central chest pain as the predominant feature and that
· we should not use response to glyceryl trinitrate (GTN) to make a diagnosis of ACS.
If we suspect an ACS, we will refer them to hospital. But NICE makes different recommendation...