Chest Pain Presentation
Suspected chronic coronary syndrome
All Pathways
CardiologyDiagnostic
Chest Pain Evaluation - Chronic Coronary Syndrome (ESC 2024)
Chest Pain Evaluation - Chronic Coronary Syndrome (ESC 2024): Chest Pain Presentation → Step 1: Initial Assessment → ACS Suspected? → ACS Pathway.
Pathway Overview
11 steps
Algorithm Steps
11 total
01Start 02Action Step 1: Initial Assessment
Rule out ACS and non-cardiac causes
- History: pain character, triggers, relief
- Rule out ACS first
- 12-lead ECG
- Basic labs (troponin if recent symptoms)
03Decision ACS Suspected?
Acute presentation, dynamic ECG, troponin rise
- If Yes
04Warning ACS Pathway
Use STEMI/NSTEMI algorithms
If No05Action Step 2: Cardiac Examination
Echo + estimate clinical likelihood
- Resting echocardiography
- Assess LV function, wall motion
- Estimate PTP of obstructive CAD
- Based on age, sex, symptom type
06Decision Pre-Test Probability?
Clinical likelihood of CAD
07Outcome Very Low PTP
Defer further testing
08Action Step 3: Diagnostic Testing
Functional or anatomical
- CTCA: Preferred low-intermediate PTP
- Stress imaging: Intermediate PTP
- ICA: High PTP or high-risk stress test
09Action Functional Testing
Stress echo, stress CMR, PET
- Assess ischemia
- Exercise ECG only if others unavailable
10Action Step 4: Establish Management
Based on test results
- Lifestyle modification
- Risk factor control
- Antianginal therapy if needed
- Revascularization if refractory or high-risk
11Action Anatomical Testing
CT Coronary Angiography
- Preferred for low-intermediate PTP
- High NPV for ruling out CAD
- Path rejoins step 10Shared downstream outcome
Guideline Source
2024 ESC Guidelines for the Management of Chronic Coronary Syndromes
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not address acute chest pain / ACS - use STEMI/NSTEMI algorithms
- Pre-test probability calculation simplified
- Assumes stable patient without red flags
Contraindicated Populations
pediatric
Applicable Regions
EUUS
EU: ESC 2024 - CTCA has expanded role for low-intermediate PTP
US: ACC/AHA similar 4-step approach
Version 1Next review: 2028-09-01
Next steps
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Related Resources
Frequently Asked Questions
What is the Chest Pain Evaluation - Chronic Coronary Syndrome (ESC 2024)?
The Chest Pain Evaluation - Chronic Coronary Syndrome (ESC 2024) is a diagnostic clinical algorithm for Cardiology. It provides a structured decision tree to guide clinical decision-making, based on 2024 ESC Guidelines for the Management of Chronic Coronary Syndromes.
What guideline is the Chest Pain Evaluation - Chronic Coronary Syndrome (ESC 2024) based on?
This algorithm is based on 2024 ESC Guidelines for the Management of Chronic Coronary Syndromes (DOI: 10.1093/eurheartj/ehae177).
What are the limitations of the Chest Pain Evaluation - Chronic Coronary Syndrome (ESC 2024)?
Known limitations include: Does not address acute chest pain / ACS - use STEMI/NSTEMI algorithms; Pre-test probability calculation simplified; Assumes stable patient without red flags. Individual patient factors may require deviation from these recommendations.
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