Chest pain
Assess chest pain, consider immediately dangerous causes and discuss a safe investigation plan.
Clinical learning outcomes: Awaiting named clinical review.
What you should learn
- Take and present a focused history and examination.
- Explain initial ECG and further testing in the context of the patient’s risk.
Recognise and explain
- Consider ACS, pulmonary embolism, aortic disease, pneumothorax and other causes; one reassuring result is not the whole assessment.
On your placement
Agree the activity and supervision with the clinical team. For patient-facing learning, seek permission and respect the patient’s comfort and care needs.
- Present a chest-pain history to a clinician.
- Review an ECG with a clinician and discuss whether troponin testing is indicated; if it is, follow the local assay pathway.
- Discuss the decision about observation, referral or discharge.
Choose the discussion case that fits your learning: a dangerous alternative diagnosis, ACS or aortic dissection.
Start here
MLA: cardiovascular history
Use the cardiovascular history questions to explore symptoms, risk and alternative causes.
Current guidance
NICE CG95: recent-onset chest pain
Read the acute chest-pain assessment section and discuss how history, ECG and further tests fit together.
NICE: chest pain when pulmonary embolism is suspected
Read the suspected-PE assessment pathway only when PE is a relevant possibility; discuss whether its decision rules apply to the patient.
Discuss
Assessing chest pain
Use an aortic presentation and a postoperative PE concern to practise a broad differential and selective investigation.
Acute coronary syndrome: initial assessment
Connect the clinical story, ECG and assay-specific troponin pathway while recognising when treatment cannot wait.
Recognising acute aortic dissection
Use two presentations to practise recognising acute aortic syndrome and communicating the need for urgent senior assessment.
Practise
One learner performs. One checks the important steps and gives feedback. Then swap. These are St Emlyn’s practice tools, not official MLA scoring systems.
Cardiovascular examination paired practice
Practise cardiovascular examination and summarise the findings; the examination does not exclude ACS, PE or aortic disease.
On your next shift
Ask which uncertainty remained when the clinician made the disposition plan.
Go deeper
Optional material. Advanced resources extend discussion; they do not define independent student practice. Check the publication date and compare clinical advice with current guidance.
Geeky Medics: chest-pain history
Use the history questions to practise the conversation; explain the important findings and the help needed to a clinician.
How this relates to GMC graduate outcomes and the MLA
These are St Emlyn’s learning connections, not a claim that this page covers every national requirement.
Presentations and conditions: Chest pain.
Clinical and professional capabilities: Assessment and clinical reasoning; Recognising limits and seeking help.
Practical skills: Cardiovascular examination; ECG recording.
St Emlyn’s interpretation of relevant GMC graduate outcomes and MLA themes; these are summary labels, not official topic codes or a complete curriculum.
Explore the student placement programme
Student practice and graduate expectations
About this resource and its review
A St Emlyn’s guide to learning Emergency Medicine during undergraduate placements. It is not an official medical-school or GMC curriculum. Your medical school’s curriculum and assessment requirements take precedence.
National foundations: GMC Outcomes for Graduates, the practical-skills supplement and the MLA content map applying from September 2026.
Framework checked: 8 October 2026. This is a source check, not clinical sign-off.
Clinical learning outcomes: awaiting named clinical review.
The four learning routes are St Emlyn’s groupings. The six interconnected MLA domains remain part of the official content map.