No ST Depression and Pain Free

Patient with no ST Depression and pain free

Perform TIMI Risk Score for UA/NSTEMI

High/Medium Risk (TIMI 3-7)

Clopidogrel 300mg (if not
contraindicated)
Fondaparinux 2.5mg

Calculate Grace Score

Refer to Cardiology Reg if patient has any of
the criteria below:

• Dynamic ECG Changes
• Patients requiring GTN infusion
• Recurrent chest pains in the ED
• Seen in cardiology OPC in the last 3 months
• Adult Congenital Heart Disease
• GRACE score >124

If no to the above repeat troponin
and administer medications:

• Bisoprolol
• ACE-I: Ramipril (as appropriate)
• Atorvastatin:80

Troponin +ve?

Yes

e-referral to cardiology if Troponin +ve

No

Repeat ECG 12 and 24 hours and senior review

Low Risk (TIMI 0-2)
AND NORMAL or Non-Diagnostic ECG

+ve 1st Troponin including A&E
panel?

Repeat Troponin
(Troponin panel for A&E patients’)

+ve 2nd Troponin including A&E
panel?

Yes

Follw the steps for High/Medium Risk above

No

Clinical diagnosis of unstable Angina?

If chest pain persists consider other causes

Refer to appropriate specialty dependent on cause

• Discharge
• Letter to GP
• Consider referral to Rapid Access Chest Pain Clinic