Assessment in hospital in patients with acute coronary syndrome

Take a resting 12-lead ECG and a blood sample for troponin I or T measurement on arrival in hospital

carry out a physical examination to determine:

• haemodynamic status
• signs of complications, for example pulmonary oedema, cardiogenic shock and
• signs of non-coronary causes of acute chest pain, such as aortic dissection

Take a detailed clinical history unless a STEMI is confirmed from the resting 12-lead ECG (that is, regional ST-segment elevation or presumed new LBBB). Record:

• the characteristics of the pain
• other associated symptoms
• any history of cardiovascular disease
• any cardiovascular risk factors and
• details of previous investigations or treatments for similar symptoms of chest pain.

Use of biochemical markers for diagnosis of an acute coronary syndrome

• take a blood sample for troponin I or T measurement on initial assessment in hospital. These are the preferred biochemical markers to diagnose acute MI
• take a second blood sample for troponin I or T measurement 10-12 hours after the onset of symptoms
• biochemical markers such as natriuretic peptides and high sensitivity C-reactive protein should not be used to diagnose an ACS
• biochemical markers of myocardial ischaemia (such as ischaemia-modified albumin) as opposed to markers of necrosis should not be used when assessing people with acute chest pain
• the clinical presentation, the time from onset of symptoms and the resting 12-lead ECG findings should be taken account when interpreting troponin measurements.

Reference:

1. Acute coronary syndromes. NICE Guidance (November 2020)