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Key points

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.

We recommend using the Heart Foundation's Clinical Guidelines for the Management of Acute Coronary Syndromes (2016).

The images below are linked to easy-to-follow pathways of care for emergency patients presenting with chest pain.

You can also download our patient fact sheet

Flowchart for the assessment of suspected acute coronary syndrome using conventional troponin testing

 Flowchart for the assessment of suspected acute coronary syndrome using point-of-care troponin testing     Flowchart for the assessment of suspected acute coronary syndrome using high sensitivity troponin testing

Diagram for the decision-making and organisation of reperfusion strategies for ST-Elevation Myocardial Infarction within 12 hours of first medical contact  with ideal time interval for interventions

Patient fact sheet

Get in touch

Clinical Guidance Team
Safer Care Victoria

Version history

First published: September 2021
Due for review: September 2024

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