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Updated NICE Guidelines
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A few of the major recommendations to highlight are: Include the typicality of anginal pain features (see recommendation in all requests for diagnostic investigations and in the person's notes. [2010, amended 2016] Use clinical judgement and take into account people's preferences and comorbidities when considering diagnostic testing. [2010] Offer 64 slice (or above) CT coronary angiography if:
  • clinical assessment (see recommendation indicates typical or atypical angina or
  • clinical assessment indicates non-anginal chest pain but 12 lead resting ECG has been done and indicates ST T changes or Q waves. [new 2016] For people with confirmed CAD (for example, previous MI, revascularisation, previous angiography), offer non-invasive functional testing when there is uncertainty about whether chest pain is caused by myocardial ischaemia. See section 1.3.6 for further guidance on non-invasive functional testing. An exercise ECG may be used instead of functional imaging. [2010]