Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Initial assessment of chest pain in primary care involves:
- Taking a detailed clinical history including age, sex, pain characteristics (location, radiation, severity, duration, frequency, provoking and relieving factors), associated symptoms (e.g., breathlessness), history of cardiovascular disease, and cardiovascular risk factors NICE CG95.
- Performing a physical examination to identify cardiovascular risk factors, signs of other cardiovascular disease, non-coronary causes of chest pain, and to exclude other causes NICE CG95.
- Assessing the typicality of chest pain based on three features: constricting discomfort in the chest or related areas, provoked by exertion, and relieved by rest or glyceryl trinitrate within about 5 minutes. Presence of three features indicates typical angina, two features atypical angina, and one or none non-anginal chest pain NICE CG95.
- Measuring vital signs including blood pressure, pulse, respiratory rate, oxygen saturation, temperature, and level of consciousness to assess for serious causes and acute illness NICE CKS.
- Taking a resting 12-lead ECG as soon as possible if stable angina cannot be excluded clinically or if acute coronary syndrome (ACS) is suspected NICE CG95.
- Not routinely offering non-invasive imaging or exercise ECG in the initial assessment of acute cardiac chest pain NICE CG95.
- Considering chest X-ray only if other diagnoses such as lung pathology are suspected NICE CG95.
- Referring urgently or as an emergency to hospital if ACS is suspected based on history, symptoms, ECG changes, or clinical instability NICE CG95,NICE CKS.
Summary: The initial assessment is primarily clinical, focusing on history, examination, vital signs, and ECG, with selective use of chest X-ray and urgent referral if ACS or serious pathology is suspected NICE CG95,NICE CKS.