Key result
ECG serves as primary primary-care triage for suspected ACS, while pre-hospital troponin is rarely indicated.
Why the study?
Chest pain diagnosis in primary care is challenging due to multiple causes including life-threatening ACS, requiring clear guidance on diagnosis and early management.
Primary care management of suspected ACS should focus on immediate ECG, initial medical therapy, and urgent hospital referral rather than outpatient troponin testing.
ECG prioritization and urgent referral guide primary care ACS suspicion; leaves open troponin utility in evolving prehospital pathways.
BACKGROUND: Chest pain is a common presentation and diagnosis can be challenging. There are many causes for chest pain, including life-threatening conditions such as acute coronary syndrome (ACS), which can prove difficult to diagnose. OBJECTIVE: This article focuses on diagnosis and early management of patients with possible ACS. Key differentials and essential primary care investigations and management are outlined. Hospital-based risk stratification and management are described, providing an outline of what patients can expect if referred to hospital. DISCUSSION: In primary care, an electrocardiogram (ECG) is the only investigation required for most patients while referral is made to hospital. Troponin testing should rarely be requested to investigate patients with suspected ACS in the primary care setting. Initial treatment may include aspirin, glyceryl trinitrate and oxygen if required. If ACS is suspected as the cause of the symptoms, urgent referral for definitive risk stratification is required.
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Thomsett et al. (2018) conducted a review in Chest pain and suspected acute coronary syndrome. Primary care assessment and management was evaluated. An electrocardiogram is the primary investigation required for patients with suspected acute coronary syndrome in primary care, whereas troponin testing is rarely indicated prior to hospital referral.
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