Rapid Access Chest Pain Clinic

 

The following guidelines are to be used when referring to RCHT. Please see the link at the bottom of this page for information on referring a patient to NDDH.

Introduction:

• The Rapid Access Chest Pain Service rapidly investigates cardiac sounding chest pain in keeping with NICE guidance.
   
• Completed forms will be triaged by chest pain nurses.
   
• The patient will be offered a remote or face to face consultation. 

 

Referral Indications:

• Chest pain* due to suspected angina eg:
  • constricting discomfort in centre of chest, jaw, arm
     
  • precipitated by exertion and stress
     
  • alleviated by rest or GTN within minutes 

Referral Exclusions:

1. Evidence of acute myocardial infarction
 

2. Symptoms suggestive of unstable angina 
 

3. Known coronary artery chronic total occlusion (CTO) 
 

4. Currently being investigated for coronary artery disease (CAD) by a Cardiologist or by the RACPC 
 

5. Previously investigated by a Cardiologist in the past 12 months and had documented CAD for medical management 
 

6. Previously investigated by a Cardiologist in the past 5 years and had normal results 
 

7. Symptoms of heart failure, valve disease or arrhythmia 
 

8. Non cardiac chest pain 
 

9. Asymptomatic coronary artery calcification** 

 

 

How to refer:

• Complete Rapid Access Chest Pain Clinic Form

If chest pain type is not typical for angina but suspicion is raised by other aspects of the history, risk factors or ECG ensure these are highlighted on the form*.

• Attach a recent ECG
• Attach patient profile including past medical history, cardiac history if relevant, medications and allergies.
• Please ensure you record whether heart sounds are normal or abnormal, and a BP otherwise the referral will be rejected

 

Pending the appointment:

• Please request baseline bloods: eGFR, FBC, lipid profile, liver function tests, thyroid function and cholesterol
• Please request a chest x-ray
• Consider initiation/ optimisation of cardioprotective medications (aspirin, beta blocker, statin and ACE-inhibitor) and additional symptomatic relief (GTN spray, oral nitrates , calcium channel antagonists  and nicorandil)

 

*Chest pain described as non anginal does not require investigation according to NICE guidance. These referrals will be rejected unless sufficient supporting information is provided (e.g. other indicators in description of the pain, past cardiac history, risk factors or abnormal investigations which heighten suspicion).

If deemed not suitable for urgent cardiac chest pain clinic yet clinical  concern remains regarding underlying ischaemia please refer to a general cardiology clinic. 

 

** Asymptomatic coronary artery calcification found incidentally on eg CT scans should not prompt further cardiology investigations in the absence of cardiac symptoms.  If there are symptoms suggestive of angina this should lower the threshold for referral. 

 

Referring To NDDH

Please click here for the NDDH referral guidelines and proforma

 

References

NICE guidance CG95, Nov 2016

 

 

Date reviewed                     23/09/2024

Next review due                  23/09/2026

Contributors                         Dr Louise Melley – Assistant Specialist Cardiology RCHT

                                             Dr B Wesson, GP & Kernow RMS Cardiology Guideline lead

                                             Dr Christopher Gibbs, Consultant Cardiologist, NDDH

 

Version 2.1