Differential diagnosis
- Cardiovascular
- Stable angina
- Typical for patient
- Constricting discomfort on exertion
- Resolves at rest/GTN within 5 minutes
- ACS
- Pain at rest
- Increasing in frequency
- Nausea, sweats, lightheadedness
- Radiation to left arm/jaw
- CV risk factors
- Duration > 15 minutes
- Pericarditis
- Worse on inspiration
- Relieved by sitting forward
- Fever
- Pericardial rub
- Acute thoracic dissection
- Radiates to back
- Inequal pulses/BP in arms
- Early diastolic murmur
- Uncontrolled BP
- Arrhythmia
- Palpitations
- Lightheadedness
- Breathlessness
- Aortic stenosis
- Ejection systolic murmur
- LVH on ECG
- Breathlessness
- Syncope
- HOCM
- FH cardiomyopathy
- Sickle cell disease
- CCF
- Ankle swelling
- Orthopnoea
- PND
- Breathlessness
- Cough
- Raised JVP
- Stable angina
- Respiratory
- PE
- Haemoptysis
- Pleuritic
- COCP
- Smoking
- Long haul travel
- Recent surgery
- Malignancy
- Pneumonia
- Fever
- Cough
- PE
- GI
- Dyspepsia
- Heartburn, reflux, nausea
- Relation to food
- Dyspepsia
- Other
- Musculoskeletal
- Worse on palpation
- Worse with certain movements
- Musculoskeletal
Data gathering
- Red flags
- See above
- Examine
- BP, (both arms) pulse (both arms)
- Temperature, Sats
- CVS, Resp
- Calves, Chest wall tenderness
Clinical management
- Treat as per cause
- If not urgent, consider
- Investigations
- Bloods – FBC, U+E, LFTs, TFTs, CRP, HbA1c, lipids
- ECG
- CXR
- Investigations
- Treatment
- Assess likelihood of CAD (see below)
- If <10% likelihood of coronary artery disease
- Consider non cardiac causes
- If >10% likelihood of coronary artery disease
- Refer rapid access chest pain clinic (if new angina) + aspirin 75mg OD
- Refer cardiology clinic (if known IHD)
- If <10% likelihood of coronary artery disease
- Assess likelihood of CAD (see below)
Table to assess likelihood of CAD