rapid access chest pain clinic
TRANSCRIPT
Rapid Access Chest Pain Clinic
Anne McCarthy
Overview
o Philosophyo What is the RACPC?o The RACPC Teamo Why was the clinic set up?o Referral Criteriao Admission Processo Risk Factors of Coronary Heart Diseaseo Central Chest Paino Services Providedo Consultant Cardiologists’ Roleo Next Stepso Diagnosis
Philosophy
“ We strive to recognise the dignity
and uniqueness of each individual
person and situation”
What is the RACPC?
o The Rapid Access Chest Pain Clinic is a facilityfor patients with recent onset or acute chestpain that requires urgent investigation.
o It provides a “one-stop” specialist diagnosticservice where patients undergo a clinicalassessment and any other investigationsnecessary to confirm or exclude heartdisease.
What is the RACPC? (continued)
o It also reassures patients with non-heart related problems.
The RACPC Team
o The RACPC Team consists of:
- Consultant Cardiologist
- RACPC Nurse
- Cardiac Technicians
- Clerical Staff
- Lab Technicians
- Angio Staff
Why was the clinic set up?
o To provide GPs with a quick assessment of patients with suspected new onset of angina.
o With early detection you have a better outcome and therefore a reduction in mortality.
Referral Criteria
o Any patient presenting with a recenthistory of chest pain.
o Pain that is suggestive of angina.
o Pain with atypical features of heart diseasebut is accompanied by significant cardiacrisks.
o Those with none Ischemic Heart Disease.
o Patients with suspected Arrhythmia.
Referral Criteria (continued)
However!
o Suspected Acute Myocardial Infarction should be admitted directly to the ICU/CCU.
Recognising Symptoms Of Heart Pain
o Although most people with Coronary Heart Disease(CHD) have the same underlying problem, i.e. narrowingof the coronary arteries, they don’t all get the samesymptoms. Some develop angina, others may have anMI.
o Heart disease affects people in different ways not allchest pain is caused by CHD. Sometimes it is not easy todistinguish chest pain cause by heart disease from anyother kinds of chest pain.
o It is also important to assess for symptoms ofArrhythmias such as Palpitations, Dyspnoea, Dizziness.
Angina
o It is brought on by exercise and goesaway when one rests. Angina usually lastsabout two to three minutes and no morethan about ten minutes. It may only comeon with exertion like walking up a hill orwalking against a strong wind or climbinga stairs. It may come on with mildexertion like dressing, worse in the cold.
Unstable Angina
o In general angina it is fairly predictable, but ifthe coronary artery narrows further or a clotforms on its surface, then the disease enters anew phase i.e. unstable angina. The patient maysuddenly find that he/she can only walk a shortdistance before developing pain or doing lightwork. Sometimes they may wake from sleepwith pain. Unstable angina can cause MI and itis important to recognise this.
Myocardial Infarction (MI)
o The pain can be the same as angina but insteadof easing off with rest the pain continues to getworse. The patient may look grey, sweaty andfeel cold to touch; they may feel sick and mayvomit. They may have had some pain on and offfor weeks or months. In about 20% of the casesthe symptoms of myocardial infarction may bemild and are often mistaken for indigestion. Thisis particularly true of elderly people anddiabetics.
Admission Process
o Patients can attend the RACPC by appointment Monday to Friday.
o We aim to see each patient as rapidly as possible and ensure that any waiting periods are kept to a minimum.
o Appointments are given to the patient directly once we have received a letter of referral from their GP.
Admission Process (continued)
o Appointments are approximately 90 minutes apart.
o Urgent referrals will be dealt with immediately.
o Patients are advised to come to the Cardiology Department.
o There are special reserved parking spaces for patients attending the RACPC Clinic.
Admission Process (continued)
o Patients are advised that a Chest Pain Nurse will carry out the initial assessment.
o They will be seen by a Consultant Cardiologist who will review their results with them.
o Appointment will last approximately 2 hours in total.
Risk Factors of Coronary Heart DiseaseAlcohol Alcohol
Lack of exercise
Lack of exercise
Lack of exercise
Stress Stress Stress Stress
Obesity Obesity Obesity Obesity Obesity
Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes
Family History
Family History
Family History
Family History
Family History
Family History
Family History
Hypertension
Hypertension
Hypertension
Hypertension
Hypertension
Hypertension
Hypertension
Hypertension
RaisedCholesterol
RaisedCholesterol
RaisedCholesterol
RaisedCholesterol
RaisedCholesterol
RaisedCholesterol
RaisedCholesterol
RaisedCholesterol
RaisedCholesterol
Smoker Smoker Smoker Smoker Smoker Smoker Smoker Smoker Smoker Smoker
Central Chest Pain
Outcome
Relieving Factor
Radiation
Onset
Type Sharp
Sharp
Localised
None
DissectingAortic
Aneurysm
Back
None
PE
Rubbing Respiration / Movement
Localised
None
Pericarditis Outcome
Relieving Factor
Radiation
Onset
Type Constricting/ Tightening
Rest
Neck Jaw Arms
None
MI
On Exertion
Neck Jaw Arms
Rest & Nitrates
AngioOutcome
Relieving Factor
Radiation
Onset
Type Burning
After Food
Neck Jaw Arms
Antacid & Nitrates
Oesophageal
Services Provided
Medical Assessmento Blood Pressureo Heart Rateo Temperatureo Weight, Height, BMIo A history of the
presenting illness in the patient’s own
wordso Past medical historyo Risk factorso Electrocardiograph
– ECGo Blood Tests – serum
cholesterol, troponin, blood sugars
Consultant Cardiologist Role
o The main precedence of the clinic is toidentify individuals at high risk of futurecoronary events. As part of the assessmentthe Cardiologist will discuss the diagnosis andpossible treatment options with the patient.
o Once the initial assessment is completed bythe nurse the case is discussed with theConsultant Cardiologist who will decide thenext steps in conjunction with the patient.
Next Steps
o Stress Test
o Echocardiogram
o Discharge Summary sent to referring GP
o Return to GP if non cardiac related
o Remain under cardiologist care for further management
Diagnosis
Patients diagnosed withheart disease will beoffered appropriatetreatment options whichmay include:
Medical Management
Immediate Coronary Angiography
Medical Management with a date for coronary angiography
Proceed to percutaneous coronary intervention/angioplasty/CABG
R.A.C.P.C.
Thank You