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Urgent Cardiac Chest Pain Service

The following guidelines are to be used when referring to RCHT. Please see the link at the bottom of this page for information on referring a patient to NDDH.

Introduction:

  • The Urgent Cardiac Chest Pain Service rapidly investigates cardiac sounding chest pain in keeping with NICE guidance.
  • Completed forms will be triaged by chest pain nurses.
  • The patient will be offered a direct appointment for an investigation e.g. MIBI, Cardiac CT, Angiogram or the patient will be seen urgently in a general cardiology clinic.
  • This has replaced the Rapid Access Chest Pain Clinic. 

 

Referral Indications:

  • For patients with chest pain*  due to suspected angina e.g:-

-  constricting discomfort in centre of chest, jaw, arm

-  precipitated by exertion and stress

-  alleviated by rest or GTN within minutes 

 

Referral Exclusions:

  • Features of acute coronary syndrome (these patients requires admission)
  • Currently under the care of cardiologist (refer back to named cardiologist)
  • Patients with breathlessness rather than chest pain (refer to general cardiology after appropriate community investigations e.g. Pro-BNP, spirometry, CXR etc.)

 

How to refer:

If chest pain type is not typical for angina but suspicion is raised by other aspects of the history, risk factors or ECG ensure these are highlighted on the form*.

  • Attach a recent ECG
  • Attach patient profile including past medical history, cardiac history if relevant, medications and allergies.

 

Pending the appointment:

  • Please request baseline bloods: eGFR, FBC, lipid profile, liver function tests, thyroid function and cholesterol
  • Please request a chest x-ray
  • Consider initiation/ optimisation of cardioprotective medications (aspirin, beta blocker, statin and ACE-inhibitor) and additional symptomatic relief (GTN spray, oral nitrates , calcium channel antagonists  and nicorandil)

 

*Chest pain described as non anginal does not require investigation according to NICE guidance. These referrals will be rejected unless sufficient supporting information is provided (e.g. other indicators in description of the pain, past cardiac history, risk factors or abnormal investigations which heighten suspicion).

If deemed not suitable for urgent cardiac chest pain clinic yet clinical  concern remains regarding underlying ischaemia please refer to a general cardiology clinic. 

 

Referring To NDDH

Please click here for the NDDH referral guidelines and proforma

 

 

References

NICE guidance CG95, Nov 2016