initial assessment of chest pain in primary care

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 ¹.
• 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 ¹.
• 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 ¹.
• Measuring vital signs including blood pressure, pulse, respiratory rate, oxygen saturation, temperature, and level of consciousness to assess for serious causes and acute illness ².
• 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 ¹.
• Not routinely offering non-invasive imaging or exercise ECG in the initial assessment of acute cardiac chest pain ¹.
• Considering chest X-ray only if other diagnoses such as lung pathology are suspected ¹.
• Referring urgently or as an emergency to hospital if ACS is suspected based on history, symptoms, ECG changes, or clinical instability ¹,².

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 ¹,².