assessment in hospital in patients with acute coronary syndrome

Last reviewed 12/2020

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.