Chest pain of recent onset: assessment and diagnosis

National Institute for Health and Care Excellence

Key priorities for implementation

Presentation with acute chest pain

  • Take a resting 12-lead electrocardiogram (ECG) as soon as possible. When people are referred, send the results to hospital before they arrive if possible. Recording and sending the ECG should not delay transfer to hospital
  • Do not exclude an acute coronary syndrome (ACS) when people have a normal resting 12-lead ECG
  • Do not routinely administer oxygen, but monitor oxygen saturation using pulse oximetry as soon as possible, ideally before hospital admission. Only offer supplemental oxygen to:
    • people with oxygen saturation (SpO2) of less than 94% who are not at risk of hypercapnic respiratory failure, aiming for SpO2 of 94–98%
    • people with chronic obstructive pulmonary disease who are at risk of hypercapnic respiratory failure, to achieve a target SpO2 of 88–92% until blood gas analysis is available
  • Do not assess symptoms of an ACS differently in ethnic groups. There are no major differences in symptoms of an ACS among different ethnic groups

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