In a primary care setting, the primary approach to differentiating aortic dissection from other causes of acute chest pain focuses on identifying any suspected serious cause that necessitates urgent hospital admission, rather than definitive diagnosis in the community NICE CKS. Aortic dissection is considered a life-threatening condition associated with a high risk of death or serious morbidity, requiring immediate admission NICE CKS,NICE CG95.
Key indicators for urgent hospital admission for acute chest pain, including suspected aortic dissection, are:
- Respiratory rate greater than 30 breaths per minute NICE CKS.
- Tachycardia greater than 130 beats per minute NICE CKS.
- Systolic blood pressure less than 90 mmHg, or diastolic blood pressure less than 60 mmHg (unless this is normal for the individual) NICE CKS.
- Oxygen saturation less than 92%, or central cyanosis (if the person has no history of chronic hypoxia) NICE CKS.
- Altered level of consciousness NICE CKS.
- Raised temperature, especially if higher than 38.5°C NICE CKS.
Initial assessment in primary care should include:
- Measurement of blood pressure, pulse rate, temperature, breathing rate, oxygen saturation, and level of consciousness NICE CKS. These assessments are also recommended by the National Early Warning Score (NEWS2) and can be applied to acutely ill people with chest pain where the cause is unknown NICE CKS.
- Taking a resting 12-lead electrocardiogram (ECG) as soon as possible NICE CKS,NICE CG95. It is important to note that a normal resting 12-lead ECG does not exclude an Acute Coronary Syndrome (ACS) NICE CG95.
If there is any suspicion of a serious cause, or any concern regarding the person's general well-being, urgent hospital admission should be arranged NICE CKS. Recording and sending the ECG should not delay transfer to hospital NICE CKS,NICE CG95. If an Acute Coronary Syndrome (ACS) is not suspected, other acute conditions, including life-threatening ones like pulmonary embolism or aortic dissection, should be considered NICE CG95.