CG95 Migrated

7/23/2019 CG95 Migrated

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C<GH H GH: GGGGHC<GH H GH: GGGGH GG GG

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© NICE 2010. All rights reserved.

http://nice.org.uk/guidance/cg95

http://nice.org.uk/guidance/cg95



CHHGCHHG

"HIH .......................................................................................................................................................................... 4

G-H .......................................................................................................................................................... 6

$M HG HH................................................................................................................................ 7

GHH KH< IH <GH ......................................................................................................................................... 7

GHH KH< GH <GH ........................................................................................................................................ 7

1 I .............................................................................................................................................................................10

1.1 J H KH< <GH ...................................................................................................... 10

1.2 GH KH< IH <GH ........................................................................................................................ 11

1.3 GH KH< GH <GH ....................................................................................................................... 18

2 HG H< G H< I .........................................................................................................................29

3 "HH ...............................................................................................................................................................30

4 +G< HG .......................................................................................................................................31

4.1 CGH-HJGG IHG C M <M I IH GHIHJ CAD

KH< H-HJ IH M GMG .......................................................................................................... 31

4.2 J G KH< IH <GH ...................................................................................... 31

4.3 +S H< IG H< J KH< <GH ............................................................................ 32

4.4 EGHG< H GHM K< I H GGGGH GH ... 33

4.5 CGH-HJGG IHG C M <M KH< IH HGH H<

GG .......................................................................................................................................................................... 34

4.6 "H IH GH L HGHG.................................................................................................... 34

5 H< JGG H<G I.................................................................................................................................36

5.1 FI I............................................................................................................................................................................... 36

5.2 "H H< I ..................................................................................................................................................... 36

6 +H "CE I..................................................................................................................................................37

7 H H< I ..................................................................................................................................................38

AL A: < I DJH I "CE H H ...................................................39

I DJH I .................................................................................................................................................. 39

Chest pain of recent onset (CG95)

© NICE 2010. All rights reserved. Page 2 of 45



C-H D &G ............................................................................................................................................................. 41

"CE H H ........................................................................................................................................................................... 41

AL B: < I +JK ..................................................................................................................42

AL C: < H<G............................................................................................................................................43

AIH H<G I ...........................................................................................................................................................44





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http://www.nice.org.uk/guidance/ta73








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https://www.gov.uk/government/publications/reference-guide-to-consent-for-examination-or-treatment-second-edition

http://www.justice.gov.uk/protecting-the-vulnerable/mental-capacity-act


http://www.wales.nhs.uk/consent






https://www.gov.uk/government/publications/reference-guide-to-consent-for-examination-or-treatment-second-edition



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45 9 47 2 22 21 70 5 43 51 92 20 79

55 23 59 4 25 45 79 10 47 80 95 38 82

65 49 69 9 29 71 86 20 51 93 97 56 84

F H< 70 KH< HM HM GMHG, GGI GHH > 90%.

F K H< 70, GGI GHH 61P90% ECE K H << G AD

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IG H H < - KH< GSH M HM GG

(CAD)

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! = !< G = HG, G <M (HH <GH > 6.47 /H).

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HM HHG H G G M HM GG. AG "H &

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SIHG KH< G EG<, K<< M H 'G

IGH H< H .



http://www.nice.org.uk/guidance/cg95/evidence




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http://www.nice.org.uk/guidance/cg94




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1.2.1.6 D H GGGG GMHG AC HM H< IG. <

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H<M IHM , IH < <GH H< GH 12 <IG, GH

12- EC G H J.

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H< GH G KG 12P72 <IG .

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GIGH) AC J IH< <GH .

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H H H< IGHG (G GH 1.2.3) H GH 12-

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HG H <GH.

1.2.1.13 " AC G H GIGH, G H< IGG H< <GH , G

K<< M -H<H (G HG 1.2.6.5, 1.2.6.6

1.2.6.7).

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1.2.2.1 GH 12- EC G G G GG. < , G

H< GIHG H <GH H<M J GG. + G H<

EC G<I H M HG H <GH.

1.2.2.2 FK HG KH< GH 12- EC G<K

-GH JH GI K H I < (BBB)

GGHH KH< IH E&" IH S GG G . CHI H

H (G H 1.2.3.4).





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GH 12- EC G<K -GH GG KJ

JG GIGHJ E&" IGH IH S GG G

. CHI H H (G H 1.2.3.4).

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AC H< H< <G H< GH 12- EC, GSM * KJG

KJ <G. CG K GH E&" ("CE

I 94) H<G HG M. CHI H H (G

H 1.2.3.4).

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1.2.2.6 " GG AC G IH, G:

H G GH 12- ECG

JK JIG GH 12- ECG

H EC G.

G IH H <K H H<G G<I . H H<H H< GIHG

M H IGJ.

1.2.2.7 H JK GH 12- ECG M <H< GG IS

H HH H< G K G H H IH IHH HHH.

1.2.2.8 " GGGGH (G G H 1.2.1.10) GH

12- EC GG AC GG M, G H< IH

HG. FGH G H<G H<H -H<H GI< G IM

G, H GGH I. CHI H H (G

H 1.2.3.4).

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&H AC G<I GHH G G G H G GIGH, IH G<I H M HG H

<GH. < HG H<G GH G<I IH H< H H H<

IGHG.









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I), IH HJIG G GI< G <, HIM

IH M H (&") G GIGH.

1.2.3.2 G G 300 G G G G GG IGG

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J KH< H< G.

M H< HHH HG <GH. FK H I

(GH E&" "CE I 94 HG

E&").

1.2.3.3 D H IHM GH LM, IH H LM GHIH IG IG

LHM G G G GG, M <GH GG. M

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KH< < GHIHJ IM GG K< H G <M

GHM I, H <J HH 2 88P92% IH G MGG G

J.

1.2.3.4 &H KH< IH <GH , IG IH H <K

H H<G G<I , IH S GG G . <G G<I I:

LHG / H< GMHG

IG GGI

<H <MH<

LM GHIH M IG LHM

H GH 12- ECG

< G HJ.







1.2.3.5 & H< H<IH HJHG IG H I (GH

E&" "CE I 94 HG E&").

1.2.41.2.4 AGGGGH <GH KH< GIGH IH M GMAGGGGH <GH KH< GIGH IH M GM

1.2.4.1 GH 12- EC G H " GIH

(G GH 1.2.5) J <GH.

1.2.4.2 CM IH <MG LH H H:

<M GHHIG

GG HG, L IM , G<

GG -M IGG IH <GH , GI< G H GGH.

1.2.4.3 H <GHM IGG E&" G S H< GH

12- EC (H<H G, -GH JH GI K BBB).

+:

H< <HGHG H<

H< GGH GMHG

M <GHM JGI GG

M JGI G HG

HG JIG JGHHG HHHG G GMHG <GH .

1.2.51.2.5 G < G < G GG IH M GMG GG IH M GM

1.2.5.1 G H " GIH H GGGGH

<GH. <G H< < G H G IH &".

1.2.5.2 G G H " GIH

10P12 <IG H H< GH GMHG.

1.2.5.3 D H IG < G GI< G HIH HG << GGHJHM

C-HJ H H G AC.









1.2.5.4 D H IG < G M G< (GI< G G<-

S I) G G H G GG K< GGGG

KH< IH <GH .

1.2.5.5 H IH H< GHH, H< H GH GMHG

H< GH 12- EC SG K< HH H

GIHG.

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1.2.6.1 < G &", IG H< IJG SH M H2

. <G

G H< HH G / G (M H)

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<MHG, <MHG.

1.2.6.2 < G H J G HH KH< GIGH AC,

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H GGH IM G) S H< GG

AC.





1.2.6.3 < G H J G HH KH< GIGH AC, K

H< H I (GH E&" "CE I

94 HG E&") IH S GG G . CHI H

H (G H 1.2.3.4).

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(GH E&" "CE I 94 HG

E&").

1.2.6.5 +GGGG KH< <GH KH<IH G H JG (H

HM H GG) IH GH 12- EC <G H

H K<H< H< <GH G M H .

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<GH H<G I (G GH 1.3). G IH H

H< H M IH< GH JGHHG.

1.2.6.6 CG <GH -M H < LI HG AC GI< G IM

, H< GG GI< G IH<L I.

1.2.6.7 M G M <GH IH H<M (C) H I IH H<GG GI< G IM G H GGH, H H G

AC.

1.2.6.8 " AC <G LI H M H H< H<KM, IH <J

G HG JGI GG, K H< H I,

L SH ("CE I 67), !MHG ("CE

I 34; M "CE I 127).

1.3 Pe$%!e %'e(e#)i#g ,i)h ()ab!e che() %ai#

<G GH H< I GGG H< GGGGH GG HHHH GH <GH

KH< GIGH GH .

A G IGIM IG M M HM GG (CAD). & GG GH

IG M CAD KH< <GH G H KMG GH<HK, H< HG

H I GIH IH. C GGGGH M GISH H S

LI GG GH , IH K< H< G IHHM, H GH HGH















(IH H HGH) I M H< GHHG < M HM GG

H 1 G I.

1.3.1.1 DG GH G H< K:

GGGGH

GGGGH IG GH HGH (H<H G, H HGH GHIHJ

CAD / IH HGH M G<).

1.3.21.3.2 C GGGGHC GGGGH

1.3.2.1 H <GHM IH:

H< GL H< G

H< <HGHG H< , I HG H, H, GJHM, IH

IM, HG H<H J J H<

M GGH GMHG, GI< G H<GGGG

M <GHM , &", M JGIGH, H< JGI GG

M JGI G HG.

1.3.2.2 CM IH <MG LH H:

HM G HG JGI GG

HM GG H< JGI GG

HM -M IGG ( L, GJ H GHGG,

MH<M)

LI H< IGG <GH .

1.3.31.3.3 & GG G GGGGH& GG G GGGGH

1.3.3.1 A G:

GHH GH H< H H< <GH, H< , G<IG, K, G





HH M <MG LH

J M GH KH< IH 5 IHG.

G GGGGH H< HMHM HIG GH K HGHH H< < CAD (G H 1):

< H< HIG J S G HM .

K H< H< HIG J S G HM .

H< HIG J S G - <GH .

1 1 H GHH H <H GHH H <JJ M HM GG H HMHM M HM GG H HMHM

GMHG, , GGMHG, , GL G HGL G HG

- <GH - <GH AHM AHM M M

& & &

A (MG) ! ! ! ! ! !

35 3 35 1 19 8 59 2 39 30 88 10 78

45 9 47 2 22 21 70 5 43 51 92 20 79

55 23 59 4 25 45 79 10 47 80 95 38 82

65 49 69 9 29 71 86 20 51 93 97 56 84

F H< 70 KH< HM HM GMHG, GGI GHH > 90%.

F K H< 70, GGI GHH 61P90% ECE K H << G AD

KH< HM GMHG K< G > 90% G<I GGI.





IG H H < - KH< GSH M HM GG

(CAD)

.

! = !< G = HG, G <M (HH <GH > 6.47 /H).

= K G = H<G H<.

< '- <GH ' IG GH KH< GMHG - <GH

, K< KI H JGHH GH IHM.

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<G GIHG M H JGHH CAD M IHG.

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H< H.

AH M DB, <K , &CHG CB H . (1993) I H< <GHM <MG HM HHG H G G M HM GG. AG "H &

118(2): 81P90.

1.3.3.2 D H S HM HM HIG <GH -

<GH HM K.

1.3.3.3 D H S HM HM HIG <GH -

<GH HM H< IG.

1.3.3.4 H< K HG, K<< GG GH M,

H IH K< GHH 'G < :

G

K<H< H< G G

JGI G HG I:

<GHM G

HG

<MHG

MG

M <GHM HI CAD





H< JGI GG

<GHM GHG< CAD, L, JIG &", M JGIGH.

1.3.3.5 " <J HIG HM G GGGGH H<

GHH < CAD G H H< 90% (G H 1), IH< GH

JGHH G IGGM. & G .

1.3.3.6 GG GIG G G G H< GHG H< <GHM G

HG, LI GG GH H< G - (G

H 1.3.3.1). H< HIG K<< GG GH

IM K< H< <GH G:

HIIG JM //

IH H HJHM //

I<H M H< //

GGH KH< GMHG GI< G NNGG, HHG, H SIHM

GKK.

CG IGG <GH H< H< (GI< G GHHGH

IGIGH ).

1.3.3.7 " H< GHH < CAD G GG H< 10% (G H 1), SGH G

IGG <GH H< H< IG M CAD.

1.3.3.8 CG JGHH H< IGG , GI< G <MH<

MH<M, KH< HM - <GH K

< CAD (GHH H GG H< 10%).

1.3.3.9 A HGHG H HM HG K<< LH , GI< G

, JGHH GH .

1.3.3.10 M G <GH -M H< GG, GI< G I HII,

GIGH.

1.3.3.11 " GG GH <G LI H M H H<

H<KM, IH <J G HG JGI GG, K H<





H I, L SH ("CE I

67), !MHG ("CE I 34; M "CE

I 127).

1.3.3.12 F K< GH H G LI H< GG

H< GGGGH , H GH 12- EC G G G GG

H GHH.

1.3.3.13 D H I IH GG GH H< GG GH

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1.3.3.14 A I <G GH 12- EC GGHH KH< CAD

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G HG.

1.3.3.15 F KH< S CAD ( L, JIG &", JGIGH,

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G GGGGH , G H 1.3.4.8 IH

IH HGH.

1.3.3.16 " KH<IH S CAD, K< GH H G

LI G GGGGH , GHH H< < CAD

(G H 1). H< GGGGH H< GH 12- EC H

IH K< H< GHH. A IH< GH HGH G

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" H< GHH < CAD G 61P90%, JGJ M <M G

H< SGH- GH JGHH H (G HG 1.3.4.4

1.3.4.5).













" H< GHH < CAD G 30P60%, IH G H< SGH-

GH JGHH (G H 1.3.4.6).

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GH JGHH (G H 1.3.4.7).

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1.3.3.18 FK HG GH 4

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1.3.4.2 G IH H H IH 'G G

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1.3.4.5 F KH< <GH K< GH H G


CAD 61P90% (G H 1.3.3.16), -JGJ IH

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1.3.4.6 F KH< <GH K< GH H G


CAD 30P60% (G H 1.3.3.16), -JGJ IH

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<M <G G<K CAD IH IH GS.

1.3.5.2 JGJ M <M G G- JGHH K< H<GIHG -JGJ IH IGJ.

1.3.61.3.6 G -G -JGJJGJ IH HGH IH HGH MM G< G<

1.3.6.1 < -JGJ IH M G< IG:

M IG GH<M KH< G <H GG IH H<M

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I 113) DMGG ("CE I 17).

2<MG $, AH #, <H !D H . < H< H EC/ACCF/A!A/!F G F

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K GG J MI K K H HM H< GG &", IH

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5 C H . (2009) "N H : G JGM H<

A !H AGGH CHH C " H< CI C CM

CHH CJGI " "HJH H< CI CJGI

+M "HJH. CIH 119(7): 1056P65.













22 HG H< G H< IHG H< G H< I

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< G H IH <K "CE IG J H< "CE KGH,

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http://www.nice.org.uk/guidance/cg95/resources/chest-paindiscomfort-of-recent-onset-scoping-workshop-consultation-and-final-scope

http://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/nice-clinical-guidelines

http://www.nice.org.uk/proxy/?sourceUrl=http%3a%2f%2fwww.nice.org.uk%2faboutnice%2fhowwework%2fdevelopingniceclinicalguidelines%2fdeveloping_nice_clinical_guidelines.jsp%3fdomedia%3d1%26mid%3d62F02D9B-19B9-E0B5-D4A26EC9A934FDC7





http://www.nice.org.uk/guidance/cg95/resources/chest-paindiscomfort-of-recent-onset-scoping-workshop-consultation-and-final-scope



33 "HH"HH

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I IH GHIHJ CAD KH< GIGH H-HJ IH M GMG.

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M I-IH CAD H-HJ IH M GG. H K K<H< H G

GH HJ KH< LG EC G SGH HGH H< GH K I H<G I.

4.2 N$+e! ca'diac bi$"a'e'( i# %e$%!e ,i)h ac*)e che() %ai#

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K GGHJ H GGMG M JHG J JIG GGMG HG

GH IM. <M M K LIG M H H< H< 12 <I

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M GG L, IH G ( L, <) J IH G

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http://www.nice.org.uk/guidance/cg95/informationforpublic






66 +H "CE I+H "CE I

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http://www.nice.org.uk/guidance/ph25



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http://www.nice.org.uk/

mailto:[email protected]



mailto:[email protected]


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