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Assessment of suspected cardiac chest pain
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> NICE guidelines 2010 ''Immediate management'' of ACS glyceryl trinitrate aspirin 300mg (not other anti-platelet outside hospital) oxygen if sats < 94% (unless COPD then aim for 88-92%) ECG ASAP but don't delay transfer ''Referral'' emergency - current chest pain or chest pain in the last 12 hours with an abnormal ECG same day - chest pain 12-72 hours ago chest pain > 72 hours ago - assess with ECG and troponin and review ''stable chest pain'' (complex tables) base assessment on pain, age, gender, risk factors 'anginal pain' - constricting discomfort in the front of the chest, neck, shoulders, jaw or arms - precipitated by physical exertion - relieved by rest or GTN in about 5 minutes if all 3 above - angina, if 2 - atypical angina, if 1 or 0 non-anginal If typical angina and risk of CAD >90% - no need to Ix further If risk of CAD ..... 61-90% Coronary angiography 30-60% Functional imaging, myocardial perfusion scan with SPECT, stress echocardiography or MR 10-29% CT calcium scoring
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