Chest pain
Excluding the six chest pain killers, using troponin pathways, Wells, PERC, YEARS and ADD-RS sensibly, and the pleuritic causes from PE to pneumothorax.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Chest pain is one of the commonest reasons adults attend Australian emergency departments. A minority have ACS, and fewer still have dissection, PE or another immediate threat.
- ECG within 10 minutes, then structure the assessment around the six killers: ACS, aortic dissection, PE, tension pneumothorax, tamponade and oesophageal rupture.
- Pretest probability decides the test. Rules (troponin pathways, Wells, PERC, YEARS, ADD-RS) are there to stop both missed diagnoses and unnecessary CT.
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Sources
- Brieger D, Cullen L, Briffa T et al. National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Comprehensive Australian clinical guideline for diagnosing and managing acute coronary syndromes 2025. Heart Lung Circ 2025;34(4):309-397. doi:10.1016/j.hlc.2025.02.102 (corrigendum Heart Lung Circ 2026;35(1):e12-e13)AU/NZNational Heart Foundation of Australia and CSANZ (Heart, Lung and Circulation), 2025
- Gulati M, Levy PD, Mukherjee D et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain. Circulation 2021;144:e368-e454American Heart Association and American College of Cardiology, 2021
- 2026 AHA/ACC Guideline for the Evaluation and Management of Acute Pulmonary Embolism in AdultsAmerican Heart Association and American College of Cardiology (Circulation), 2026
- 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism, developed in collaboration with the European Respiratory SocietyEuropean Society of Cardiology, 2019
- Mazzolai L, Teixido-Tura G, Lanzi S et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J 2024;45:3538-3700European Society of Cardiology, 2024
- Vrints C, Andreotti F, Koskinas KC et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J 2024;45:3415-3537European Society of Cardiology, 2024
- Roberts ME, Rahman NM, Maskell NA et al. British Thoracic Society Guideline for pleural disease. Thorax 2023;78:s1-s42British Thoracic Society, 2023
- Nazerian P, Mueller C, Soeiro AM et al. Diagnostic accuracy of the aortic dissection detection risk score plus D-dimer for acute aortic syndromes: the ADvISED prospective multicenter study. Circulation 2018;137:250-258Circulation, 2018
- Last updated
- 14 November 2026
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