Chest pain

This guideline is recommended for assessing adult patients who present to the emergency department with chest pain, where acute coronary syndrome is suspected.

To determine the pathway that should be used, refer to the local troponin assay used. 

The timing of the repeat troponin is related to the timing of first troponin at presentation and not from the timing of the pain.

Patients may not need non-invasive coronary artery testing if:

• they are under 40
• present with atypical symptoms for angina
• have no known risk factors for coronary artery disease
• have normal troponin and ECG and remain symptom free.

Other life threatening causes of chest pain to consider include aortic dissection, pulmonary embolism and tension pneumothorax.