Chest pain (non-emergent) referral checklist

Urgency tier

• Ongoing chest pain at rest or escalating frequency.
• Syncope, severe dyspnea, or hemodynamic instability.
• New ischemic changes on ECG.
• Suspected acute coronary syndrome or elevated troponin.
• Signs of heart failure or aortic dissection.

Minimum pre-referral workup

• Detailed symptom history, risk factors, and cardiovascular exam.
• Resting ECG with interpretation.
• Recent vitals and blood pressure trends.
• Lipid profile and A1C if not up to date.
• Consider chest x-ray if respiratory symptoms present.

Referral packet checklist

• Pain characteristics, triggers, and relief factors.
• Functional capacity and exercise tolerance.
• ECG findings and cardiovascular risk profile.
• Relevant labs and imaging.
• Current cardiac medications and comorbidities.

Pre-referral optimization tasks

• Confirm interim symptom-monitoring plan and medication adherence.
• Reinforce emergency activation instructions for recurrent rest pain or worsening dyspnea.
• Arrange short-interval follow-up while referral is pending.

References

• 2021 AHA/ACC guideline for evaluation of chest pain (opens in a new tab)

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