Chest pain

This condition is treated in the Cardiology clinic.

Emergency Referral Criteria

Criteria for Emergency include: 

• Suspected acute coronary syndrome
• Suspected pulmonary embolism or aortic dissection
• Suspected or confirmed endocarditis, myocarditis, or pericarditis
• Suspected ischemic chest pain within 24 hours with any of the following concerning features:
  • severe or ongoing chest pain
  • chest pain that is new at rest or with minimal activity
  • chest pain that is associated with severe dyspnoea
  • chest pain that is associated with syncope/pre-syncope
  • chest pain that is associated with any of the following signs:
    • respiratory rate greater than 30 breaths per minute
    • tachycardia greater than 120 beats per minute
    • systolic BP less than 90mmHg
    • heart failure/suspected pulmonary oedema
    • ST elevation or depression
    • complete heart block
    • new left bundle branch block

If you, or someone else, are experiencing a serious and life-threatening injury or illness call triple zero (000) immediately or go to the nearest Emergency Department.

Learn more about when to access emergency care and non-emergency care options if the injury or illness is not serious or life-threatening.

Statewide Referral Criteria (SRC)

Criteria for referral to public hospital specialist clinic services

? Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Urgent (Category 1)

• New cardiac chest pain of a possible cardiac origin but without any of the listed Emergency Referral Criteria concerning features
• Worsening pattern of angina in patients with established coronary heart disease but without any of the listed Emergency Referral Criteria concerning features
• Low risk of cardiac chest pain with 3 or more cardiac risk factors
  • Cardiac Risk Factors
    - aged over 65 years
    - hypertension
    - diabetes
    - dyslipidaemia
    - current or recent smoking
    - first degree relatives with premature coronary artery disease (men aged under 55 years and women aged under 65 years).

Urgent referrals should be accompanied by a phone call to the Consultant/Registrar to organise urgent review.

Semi-urgent (Category 2)

• Chronic chest pain of a suspected cardiac origin not previously investigated but without any of the listed Emergency Referral Criteria concerning features
• Low risk of cardiac chest pain with 2 or less cardiac risk factors:
  • Cardiac Risk Factors
    - aged over 65 years
    - hypertension
    - diabetes
    - dyslipidaemia
    - current or recent smoking
    - first degree relatives with premature coronary artery disease (men aged under 55 years and women aged under 65 years).

Routine (Category 3)

• Unlikely to be cardiac chest pain but no found cause for pain

Information to be included in the referral

(Referral may be returned without this)

Essential supporting information

Pathology

• FBC
• UEC
• LFT
• Lipids (cholesterol, TG, HDL, LDL)
• HbA1c (if diabetic)

Imaging

• Nil essential

Investigations/other

• ECG

Additional information

• Description of relevant signs or symptoms
• Relevant medical history and comorbidities
• Current and complete medication history (including non-prescription medicines, herbs and supplements and recreational or injectable drugs)

Interim/GP management

To refer a patient with this condition, please see the Cardiology clinic page for the full referral process and templates.

Other information which may be useful for triage:

• Investigations relevant to significant comorbidities
• Cardiovascular risk assessment score
• Other investigations (if available) including CXR, cardiac imaging: stress test, stress echo or myocardial perfusion scan
• History of alcohol intake and drug use (including recreational drugs)

Interim management advice can be found at HealthPathways Tasmania.

For more information please see HealthPathways Tasmania

Additional resources

View more information on the Heart Foundation website

View all clinic availability