Home

Assessment of chest pain

The evaluation of atraumatic chest pain requires an algorithmic approach that first excludes acute myocardial ischaemia before working through the various aetiologies of chest pain. It is important to check whether the patient still has pain, and if not, to find out when his or her last episode of pain occurred. [18 When your patient has chest pain, you'll need to use your assessment skills to determine whether the patient is having an acute MI or some other life-threatening illness. By knowing the signs and symptoms of the various causes for chest pain, you can quickly assess and determine whether the patient has a life-threatening condition and provide appropriate and possibly lifesaving care

Assessment of chest pain - Diagnosis Approach BMJ Best

  1. Assessment of chest pain should focus on the history of the pain, cardiovascular risk factor profile, previous personal history of ischaemic heart disease and prior relevant investigation. All but the history of chest pain has been presented in part one and two of this series
  2. A normal troponin level at least six hours after the onset of chest pain in combination with normal or near-normal ECG findings is a good prognostic sign; only one in 300 patients with this..
  3. Emergency Department Assessment of Chest Pain Score (EDACS) - MDCalc Emergency Department Assessment of Chest Pain Score (EDACS) Identifies chest pain patients with low risk of major adverse cardiac event

In May 2006 the Chest Pain Evaluation Area Toolkit was released by the Health Services Performance Improvement Branch. Research relating to the use of existing pathways and in conjunction with the repeated findings of Root Cause Analyses and Coronial investigations, highlights some common issues to be Acute coronary syndrome pathway - Assessment and Management of Chest Pain: Nurse only clinic. Details Publication Type Document Topic Policies and guidelines Date Published 17 Sep 2014 Size 1 page Update Frequency Annual Available format pdf Author Department of Health & Human Services. Downloads Taking a comprehensive chest pain history is an important skill that is often assessed in OSCEs. This guide provides a structured framework for taking a chest pain history in an OSCE setting. Download the chest pain history taking PDF OSCE checklist, or use our interactive OSCE checklist. You may also be interested in our cardiovascular history. 9 they have further chest pain. 10 1.2 People presenting with acute chest pain 11 This section of the guideline covers the assessment and diagnosis of people 12 with recent acute chest pain or discomfort, suspected to be caused by an 13 acute coronary syndrome (ACS). The term ACS covers a range of condition the clinical presentation of chest pain. Assessment of chest pain should focus on the history of the pain, cardiovascular risk factor profile, previous personal history of ischaemic heart disease and prior relevant investigation. All but the history of chest pain has been presented in part one and two of this series

The PQRST method of assessing pain is a valuable tool to accurately describe, assess and document a patient's pain. The method also aids in the selection of appropriate pain medication and evaluating the response to treatment. Nurses can help patients more accurately report their pain by using these very specific PQRST assessment questions The clinical characteristics of the chest pain, age, past medical history of cardiovascular disease, gender, and abnormalities in the ECG were the predictors of CAD most commonly reported across the studies Assessment. How should I assess a person with chest pain? The initial aim of assessment is to identify, or exclude a serious cause of chest pain which needs immediate hospital admission, such as acute coronary syndrome. To determine the cause of chest pain: Take a detailed medical history. Examine the person Tip #4: Assess Pain and Other Symptoms Assess Chest Pain. Chest pain can come in many different forms. Also, chest pain can be described as pressure or tightness. Likewise, the patient can complain of indigestion, burning, or numbness. Cardiovascular pain is usually located mid to left sternum but can radiate to the jaw, shoulder, neck, or arm Chest pain is a common chief complaint, accounting for approximately 5% of all emergency department visits in the US per year. It is the presenting complaint in 1% of clinic-based visits. In the UK, 1% to 2% of adults attend primary care each year with a new presentation of chest pain. In Belg..

The algorithm should be read with the recommendations in this document. The updated algorithm includes the new 2016 recommendations. This section of the guideline covers the assessment and diagnosis of people with recent acute chest pain or discomfort, suspected to be caused by an acute coronary syndrome (ACS) CHEST PAIN ASSESSMENT ALGORITHM. Treadmill Exercise Stress Testing Stress testing is also known as treadmill testing or graded exercise testing. During the test you will be asked to walk on a treadmill which gradually increases the speed and slope. Your electrocardiogram (ECG), blood pressure and symptoms will be continuousl Chest pain is a common chief complaint. It may be caused by either benign or life-threatening aetiologies and is usually divided into cardiac and non-cardiac causes. James E. Brown, Professor and Chair, Wright State University Boonshoft School of Medicine, Kettering, Ohio, gives us an overview of assessing chest pain in the emergency setting

The aim of chest pain assessment. There is a dichotomy in the assessment of patients with possible ACS. First, early and accurate identification of patients with ST-segment-elevation myocardial infarction (STEMI) enables provision of emergency reperfusion therapy, which has a major impact on outcome, while accurate identification of patients with other types of ACS (non-ST-segment elevation. This guideline covers assessing and diagnosing recent chest pain in people aged 18 and over and managing symptoms while a diagnosis is being made. It aims to improve outcomes by providing advice on tests (ECG, high-sensitivity troponin tests, multislice CT angiography, functional testing) that support healthcare professionals to make a speedy and accurate diagnosis Chest pain of recent onset is a common presenting symptom. In Primary Care up to 15 % of patients with chest pain have coronary artery disease (CAD), including angina pectoris and myocardial infarction, and this proportion increases to 22 % in Emergency departments and 28 % in Cardiology clinics [1-3].However, the diagnosis of CAD among patients reporting chest pain remains difficult Differential diagnosis of chest pain A number of life-threatening and minor conditions may present with chest pain. Where minor conditions are confidently diagnosed, referral to the emergency department may not be necessary. Serious conditions include ACS, pulmonary embolism, aortic dissection and spontaneous pneumothorax (Box 1). Background: For chest pain patients without ST-segment elevation in the pre-hospital setting, current clinical guidelines merely offer in-hospital risk stratification and management, as opposed to chest pain patients with ST-segment elevation for whom there is a straightforward pre-hospital strategy for diagnosis, medication regimen and logistics

Assessing chest pain accurately : Nursing202

Valentino Oriolo and John W Albarran present a systematic approach to assessing patients presenting with chest pain, and consider the management strategies that would be employed following this, in line with the latest NICE guidanc Chest Pain? Chest pain/Angina pectoris is the feeling of squeezing dull aching pain acute onset of severe retrosternal chest pain or pressure. Assessment of Chest Pain (Abid et al., 2015) The Hearthrobs : Antanisha Moore Dalidah Andre Daniella Andre Esther Chauvet Summary o Chest Pain--- PQRST - Assessment 1. PAIN 2. Pain is an unpleasant feeling often caused by intense or damaging stimuli Pain is an unpleasant sensory and emotional. Typical descriptions of chest pain from myocardial ischemia may include: Squeezing ‐ A band‐like sensation is felt around the chest. Tightness ‐ There is a sensation of a knot being present in the center of the chest. Pressure ‐ A sensation of a lump in throat or a heavy weight on the chest

Continuing Education - Cardiology - Assessment of chest pai

  1. Chest pain has many possible causes, all of which need medical attention. Heart-related causes. Examples of heart-related causes of chest pain include: Heart attack. A heart attack results from blocked blood flow, often from a blood clot, to your heart muscle. Angina. Angina is the term for chest pain caused by poor blood flow to the heart
  2. Brian Foster Chest Pain Shadow Health Assessment. Introduction and Pre-brief. This assignment provides the opportunity to conduct a focused exam on Brian Foster, who presents with recent episodes of chest pain in a non-emergency setting. Interview Mr. Foster and be sure to thoroughly assess the cardiovascular system as well as related body.
  3. e the best treatment; » Monitor the pain to deter

Background: The clinical assessment of patients with chest pain of recent onset remains difficult. This study presents a critical review of clinical predictive tools for the assessment of patients with chest pain. Methods: Systematic review of observational studies and estimation of probabilities of coronary artery disease (CAD) in patients with chest pain Assessing chest pain requires healthcare practitioners to have knowledge of its causes and pathophysiology, the use of structured assessment tools and the latest evidence-based guidelines. Nursing Standard . 34, 4, 59-66. doi: 10.7748/ns.2019.e11384. This article has been subject to external double-blind peer review and checked for plagiarism.

Evaluation of Chest Pain in Primary Care Patients - Point

  1. Background: Patients referred to our Rapid Access Chest Pain Clinic (RACPC) are seen within 2 weeks; however, the referrals must fulfill certain criteria: 1) no previous history of ischaemic heart disease 2) chest pain less that 6 weeks duration and 3) never been investigated in the past. Exclusion criteria includes severe aortic stenosis, uncontrolled hypertension, left bundle branch block.
  2. • Evaluation of chest pain in patients with suspected acute aortic syndromes, myocarditis, pericarditis or pulmonary embolism. Not recommended: • Evaluation of chest pain in patients for which a non-cardiac aetiology is apparent; • Evaluation of ongoing chest pain in patients with a confirmed diagnosis of myocardial ischaemia/infarction
  3. In general, chest pain is the leading symptom in patients with ACS diagnosed upon admission. There is an agreement that assessment of the pain character usually indicates the diagnostic direction but is unreliable as an exclusive tool for initial assessment and to be evaluated with caution . Table 2 gives an overview of typical and atypical symptoms of angina pectoris
  4. Chest pain is very common, and in the United Kingdom about 1% of visits to a general practitioner, 5% of visits to the emergency department, and 25% of emergency hospital admissions are for this symptom.1 Chest pain has many causes, and when the cause could be cardiac in origin, appropriate and timely assessment and diagnostic investigation are needed
  5. Formulating an accurate differential diagnosis within a very short timeframe and differentiating between an acute chest pain of cardiac or aortic origin and non-cardiac chest pain is a major challenge for all those involved in triage, clinical assessment and treatment of patients presenting with acute chest pain, such as general practitioners, emergency medical services (EMS) personnel.
  6. Pain is usually unaltered by movement, respiration or the position of the patient. The patient can also complain of difficulty in breathing, nausea, hypotension, diaphoresis (sweating) and restlessness. These signs and symptoms are only typically representative of cardiac related chest pain, each patient can exhibit different signs and symptoms
  7. e some basic facts

Your doctor might treat chest pain with medication, noninvasive procedures, surgery, or a combination of these methods. Treatment depends on the cause and severity of your chest pain CHEST PAIN MARYAM JAMILAH BINTI ABDUL HAMID 082013100002 IMS BANGALORE 2. Learning Outcome • Definition • Type of chest pain • Etiology • Characteristic of cardiac chest pain • Ischaemic cardiac pain vs non-cardiac chest pain • Differential diagnosis 3. Chest Pain Definition: A general term for any dull, aching pain in the thorax Chest pain is a very common symptom; 20% to 40% of the general population will experience chest pain during their lives,1 and in the UK, up to 1% of visits to a general practitioner are because of chest pain.2 Approximately 700 000 visits (5%) to the emergency department in England and Wales and up to 25% of emergency hospital admissions are because of chest pain.3 There are many causes of. Triage Nurses: Questions for Chest Pain & Chest-Related Symptoms. When a patient presents with chest pain or chest-related symptoms, the role of the triage nurse is to critically evaluate the relationship of risk factors to outcome potentials to make the best triage decisions. The more risk factors a patient has, the greater the triage nurse. Presentation. A full cardiovascular assessment is essential (see the separate article on Cardiovascular History and Examination).. Chest pain due to cardiac ischaemia typically tends to be retrosternal or epigastric, tight and crushing in quality, and may radiate to the arms, shoulders, neck or jaw

An unexpected episode of chest pain in a patient is a clinical priority and requires the evaluation of key signs and symptoms. This article examines some of the difficulties encountered, the rationale for conducting chest pain assessment and the importance of actively listening to the patient The most common causes of chest pain in the primary care population are chest wall pain (20 to 50 percent), reflux esophagitis (10 to 20 percent), and costochondritis (13 percent). This topic reviews those causes of chest pain that are most common in primary care practice and the office-based diagnostic approach to chest pain

FOCUSED ASSESSMENT OF ADULT WITH CHEST PAIN 5 used to determine inflammation that is related to pericarditis (Dains, Baumann, & Scheibel, 2016). Differential Diagnosis The most important potential diagnosis for a patient experiencing acute chest pain is determining if it is a myocardial infarction. The patient usually reports the onset of pain as sudden pain at rest Emergency Department Assessment of Acute-Onset Chest Pain. The Centers for Disease Control and Prevention states that chest pain is one of the most common reasons for visits to the emergency room made by individuals older than 15. Chest pain can have a variety of causes with several implications, making it one of the most challenging symptoms.

Emergency Department Assessment of Chest Pain Score (EDACS

In fact, over 5% of all ED visits are due to chest pain-related complaints. Despite significant investigation into risk stratification scores and a multiplicity of proposed diagnostic algorithms and testing strategies, upwards of 2% of chest pain syndrome patients will be discharged home and be subsequently diagnosed with an acute myocardial infarction within 1 week A lecture on evaluating a patient with chest pain by Dr. Kim Eagle, M.D. This lecture was taught as a part of the University of Michigan Medical School's M2. EDITOR—Rapid assessment of chest pain continues to attract the attention of healthcare planners and providers involved in the management of this common emergency. Wood et al's editorial on this subject makes cogent arguments for a clinical trial to assess the impact of rapid medical and surgical management of exertional angina. 1

The known Detailed assessment of patients presenting to emergency departments (EDs) with a suspected acute coronary syndrome (ACS) is inefficient, as most will not have an ACS.. The new The Improved Assessment of Chest pain Trial (IMPACT) protocol maintained clinical safety while reducing the time required for chest pain investigation.It identified low risk patients for whom further objective. The search methodology used was (EDACS.mp. OR ED-ACS.mp. OR Emergency Department Assessment of Chest Pain Score.mp.). This was conducted on May 7, 2020. Eligible studies required a group of adult patients presenting with 5 minutes of chest pain or other symptoms of acute coronary syndromes in the ED

Acute chest pain is a leading cause of Emergency Department visits. Computed tomography angiography plays a vital diagnostic role in such cases, but there are several common challenges associated with the imaging of acute chest pain, which, if unrecognized, can lead to an inconclusive or incorrect diagnosis Objective: To examine the safety and efficacy of the Improved Assessment of Chest pain Trial (IMPACT) protocol, a strategy for accelerated assessment of patients presenting to emergency departments (EDs) with chest pain. Design, setting and participants: IMPACT was an intervention trial at a single tertiary referral hospital (Royal Brisbane and Women's Hospital) during February 2011 - March. It has been shown in many countries that inadequate pain assessment is common, with resultant failings in management of pain. 13, 15, 19, 24, 50 Only by regularly assessing and measuring pain, as routinely as the other vital signs, can we hope to make pain visible enough to those caring for patients and thus improve management. 12 This is.

Assessment and Management of Chest Pain: Nurse only clinic

Acute chest pain in the emergency department (ED) is one of the most daunting health care challenges. In 2006, there were 119.2 million visits to hospital EDs in the United States [].According to the latest National Hospital Ambulatory Medical Care Survey, the most common specific reasons given by adult patients (15 years and older) for visiting the ED were, in descending frequency, chest pain. Chest pain can be serious. It may be caused by temporary poor blood flow to the heart (angina), or by a sudden blockage in the coronary arteries resulting in a heart attack. If you have chest pain, seek urgent medical help. Call 000 for an ambulance. There are other possible causes of chest pain such as indigestion and muscle strain Chest pain generally originates from one of the organs in the chest (heart, lung, or esophagus) or from the components of the chest wall (skin, muscle, or bone). Occasionally, organs near the chest, such as the gallbladder or stomach, can cause chest pain. Pain in the chest may also be the result of referred pain from the neck or shoulder joint The Vancouver Chest Pain Rule was derived using risk factors, pain characteristics, ECG findings and cardiac biomarkers to assist clinicians with this task.5 The recently derived emergency department assessment of chest pain score accelerated diagnostic protocol (EDACS-ADP)6 uses similar clinical features with ECG and cTn as the only biomarker Advanced physical assessment Advanced Physical Assessment Assignment 3 American Sentinel University Introduction This student will present a patient from the shadow health environment. The patient, Brian Foster a fifty-eight-year-old male complaining of chest pain

Chest Pain History OSCE Guide Communication Skills

Chest pain patients and AMI assessment Patients with a chief complaint of chest pain suggestive of acute myocardial infarction (AMI) represent one of the most common ED presentations. As highly effective but time-dependent interventions for AMI exist, these patients are typically prioritized for assessment The prevalence of chest pain is variable, ischemic heart disease is one of the most frequent causes with high morbidity and mortality. This paper reports the case of a 21-year-old male, who. Chest Pain Assessment: When Your Patient Has Chest Pain One of the most important skills available to the healthcare worker in this situation is the ability to perform an accurate pain assessment. This is particularly the case when a patient is experiencing chest pain, as it will help to determine whether the pain is cardiac in nature Chest Pain Evaluation This guideline is a uniform algorithm for Mercy Medical Center and Medical Associates Clinic and Health Plans. Non Cardiac pain workup as appropriate without routine rule out MI protocol Resolve, stable, <30 minute pain (stable exertional angina-even recent new onset Chest Pain Assessment in the Emergency Department Chest pain accounts ~10% of all presentations 10-15% are serious conditions About 10-12% cardiac About 2-3% other serious causes (PE, dissection) Need safe ways to accurately identify serious causes

Cardiovascular Care Nursing Mnemonics and Tips - NurseslabsChestPain

780 CHESTPAIN Hedges et al. ASSESSMENT OF CHEST PAIN ONSET The contributions of Chris Bundy, Douglas Harlett, G. Toria 1s. Turi ZG, Stone PH, Muller JE,et al. Implication of acute Jerome, and Mike Harms to development of the survey instru- intervention related to time of hospital arrival in acute myo- ment and data collection are greatly. Chest Pain . FOCUSED HISTORY . History of Present Illness . Note: Patients may call chest symptoms pressure, discomfort, tightness, funny feeling, etc. Differential diagnosis of chest pain is generated almost entirely by history, with some addition of EXG, chest X-ray, and specific laboratory exams. This list of questions is not exhaustive. 1 Approximately 1 percent of primary care office visits are for chest pain, and 1.5 percent of these patients will have unstable angina or acute myocardial infarction. The initial goal in patients. A patient presents to the hospital with chest pain and it's your job to work through the clinical case scenario to reach a diagnosis. Clinical Examination A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes

Know Your Stomach Pain Location Cheat Sheet - NCLEX Quiz

Chest Pain This emergency scenario reviews chest pain in a primary care patient, and is set up for role-play and case review with your staff. 1) The person facilitating scenarios can print out the pages below. 2) Cut up the role pages, and assign several roles, distributing the roles to appropriate participants in clinic Health assessment in nursing fifth edition Janet R. Weber / Jane H. Kelley Posterior Thorax INSPECTION Inspect configuration. While the client sits with arms at the sides, stand behind the client and observe the position of scapulae and the shape and configuration of the chest wall. Scapulae are symmetric and nonprotruding. Shoulders an Chest pain is an important presentation in primary care. Clinical assessment can be a challenge, as there are many potential causes of chest pain, ranging from benign to life-threatening. Since referring all patients to chest pain clinics is neither feasible nor appropriate, this article aims to help you differentiate between chest pain requiring urgent action, such as acute coronary syndrome.

Pro Tip: The cardiovascular system is inextricably balanced with many other body systems, including the gastrointestinal system. Excessive gas in a patient complaining of chest pain is a symptom worth investigating. Brian foster chest pain shadow health assessment Subjective Dat Pain assessment: is a multidimensional observational assessment of a patients' experience of pain. Pain measurement tools: are instruments designed to measure pain. Assessment. Pain assessment is a broad concept involving clinical judgment based on observation of the type, significance and context of the individual's pain experience

This NICE Pathway covers: assessing and diagnosing recent-onset chest pain of suspected cardiac origin in people with acute chest pain and a suspected acute coronary syndrome, and people with intermittent stable chest pain and suspected stable angina. early management of stable angina. Updates NREMT Patient Assessment of the Medical Patient experiencing Chest PainThis demonstration has been performed systematically at a medium pace to aid you in th..

Chest pain of recent onset: Assessment and diagnosis of

Table 1 Cardiology Causes of chest pain 3 Assessment of

PQRST Pain Assessment Method - Crozer Healt

The initial assessment of patients presenting with chest pain in your office should serve to identify patients with life-threatening conditions who need to be transferred to the emergency department. The evaluation should then proceed to a thorough history and physical examination which are used to assess the probability of various causes of. Chest Assessment Nursing (Heart and Lungs) This article will explain how to assess the chest (heart and lungs) as a nurse. This assessment is part of the nursing head-to-toe assessment you have to perform in nursing school and on the job. During the chest assessment you will be assessing the following structures: Overall appearance of the chest The concept of a chest pain clinic is not new, 5 and the rationale for rapid assessment of this symptom is simple. Firstly, exertional cardiac chest pain is common, frightening for the patient, and worrying for general practitioners and casualty officers since it can be difficult to distinguish cardiac from non-cardiac pain

Clinical assessment of patients with chest pain; a

Department Assessment of Chest Pain Score (EDACS) is recommended although there are other low risk tools available. If a patient is not high or low risk, he/she is intermediate risk. In high risk populations, ACS can present at a younger age. 5,6. This includes people with diabetes Mental health-related chest pain may feel similar to a heart attack. You may also have heart palpitations and shortness of breath. Items 25-26 are related to mental health causes of chest pain Abstract. Introduction: Postoperative pain is an unpleasant experience for patients after thoracic surgery. It is known that these types of surgical procedures cause high intensity of pain. Proper nursing assessment of the patients' pain is critical as for the right decision to be made in terms of offering quality care and support

15 patient safety11PPT - Scene Size-Up PowerPoint Presentation - ID:2734216Chest Pain Test – Heart and Lung X-Ray, ECG Stress TestsBoils - myDr

Assessment Diagnosis Chest pain CKS NIC

Watch a exploratory radial catheterization procedure at

Nursing Assessment of the Cardiovascular Syste

A combination of open and closed questions will yield better patient data. The following details are facts of the patient's case. Chief Complaint Finding: Established chief complaint Finding: Reports chest pain (Found) Pro Tip: Asking a patient broadly about their chief complaint allows them to answer in their own words and confirm information that you may have already received from another.

Mould Identification: A Virtual Self Assessment | Mycology

Assessment of chest pain - References BMJ Best Practic

Low-risk cardiac chest pain at Birmingham City Hospital (BCH) is managed through its ambulatory medical assessment area (AMAA). The pathway receives referrals from two streams, the emergency department (ED) and general practice. It follows a clear pathway, including patients being pain free with no This article aims to provide a concise, structured approach to the child with chest pain. Chest pain is a common presenting symptom in children but, unlike in adults, the cause is rarely cardiac. We review the main causes of chest pain in children and discuss the important features that may alert those assessing paediatric chest pain to serious underlying pathology

NICE chest pain guideline NICE guideline Guideline

Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with nausea, sweating, or shortness of breath. It can be divided into heart-related and non-heart-related pain. Pain due to insufficient blood flow to the. Chest pain is one of the most common jobs that paramedics attend. Correct assessment and treatment of chest pain by paramedics (when it is caused by an acute coronary syndrome) will determine if the patient lives and how much of a quality of life the patient will have after treatment

Clinician feedback was used to improve the clinical plausibility and the usability of the final score (Emergency Department Assessment of Chest pain Score [EDACS]). EDACS was combined with electrocardiogram results and troponin results at 0 and 2 h to develop an ADP (EDACS-ADP) Assess the patients breathing - Is the patient breathing adequately? With the airway open, place your ear over the patient's nose and mouth and watch for chest movement, note symmetry or lack of symmetry in chest movement. Listen and feel for the presence of exhaled air. Listen to the quality of the breath sounds approach to the child with chest pain. Chest pain is a common presenting symptom in children but, unlike in adults, the cause is rarely cardiac. We review the main causes of chest pain in children and discuss the important features that may alert those assessing paediatric chest pain to serious underlying pathology. In the vast majorit A variety of names have also been used in describing patients with NCCP. You may hear your doctor or other health care professional call it: atypical chest pain, chest pain of undetermined origin, unexplained chest pain, functional chest pain, soldier's heart, irritable heart, sensitive heart, neurocirculatory asthenia, DaCosta's syndrome, and chest pain with normal coronary angiograms He tells you that he has been experiencing central chest pain and an uncomfortable tightness in his chest since he woke this morning. Further assessment reveals that he is diaphoretic with cool peripheries, his respiratory rate is 18, heart rate 115, blood pressure 105/60 and SpO2 97% on room air Acute assessment of possible cardiac chest pain. Louise Cullen, William Parsonage. Already a subscriber? Login here for full access. Purchase Pdf A$21.99. Go to CPD. Figures. Tools. Reprints & Permissions; Abstract. Many changes have occurred recently in the assessment of patients presenting with possible acute coronary syndromes. The.