GP Vivas · cardiovascular-health
Chest pain triage in primary care — structured viva
Structured oral on chest pain triage: defending the Marburg Heart Score with validation numbers, using high-sensitivity troponin pathways correctly, arguing the NICE CG95 CTCA-first strategy against functional imaging, managing non-cardiac causes honestly, and medico-legal documentation.
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Study tools
Target exams
RACGP CCEFRACGP oralsMRCGP SCA
Prompt
The examiner opens: 'Every chest pain goes to hospital — that is safe practice.' The viva branches through triage evidence, troponin pathways, CTCA versus functional testing, non-cardiac management, and documentation.
Stem
A partner proposes that all chest pain must be sent to the emergency department. You are asked to present the alternative. [12]
References14ShowHide
- [1]Verdon F, Burnand B, Herzig L, Junod M, Pécoud A, Favrat B Chest wall syndrome among primary care patients: a cohort study. BMC Fam Pract, 2007.PMID 17850647
- [2]Verdon F, Herzig L, Burnand B, Bischoff T, Pécoud A, et al. Chest pain in daily practice: occurrence, causes and management. Swiss Med Wkly, 2008.PMID 18561039
- [3]Douglas PS, Hoffmann U, Patel MR, Mark DB, Al-Khalidi HR, et al. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med, 2015.PMID 25773919
- [4]Haasenritter J, Donner-Banzhoff N, Bösner S Chest pain for coronary heart disease in general practice: clinical judgement and a clinical decision rule. Br J Gen Pract, 2015.PMID 26500322
- [6]Timmis A, Roobottom CA National Institute for Health and Care Excellence updates the stable chest pain guideline with radical changes to the diagnostic paradigm. Heart, 2017.PMID 28446550
- [7]Kelion AD, Nicol ED The rationale for the primacy of coronary CT angiography in the National Institute for Health and Care Excellence (NICE) guideline (CG95) for the investigation of chest pain of recent onset. J Cardiovasc Comput Tomogr, 2018.PMID 30269897
- [8]Neumann JT, Twerenbold R, Ojeda F, Sörensen NA, Chapman AR, et al. Application of High-Sensitivity Troponin in Suspected Myocardial Infarction. N Engl J Med, 2019.PMID 31242362
- [10]Singh T, Bing R, Dweck MR, van Beek EJR, Mills NL, et al. Exercise Electrocardiography and Computed Tomography Coronary Angiography for Patients With Suspected Stable Angina Pectoris: A Post Hoc Analysis of the Randomized SCOT-HEART Trial. JAMA Cardiol, 2020.PMID 32492104
- [11]Manten A, De Clercq L, Rietveld RP, Lucassen WAM, Moll van Charante EP, Harskamp RE Evaluation of the Marburg Heart Score and INTERCHEST score compared to current telephone triage for chest pain in out-of-hours primary care. Neth Heart J, 2023.PMID 36580267
- [12]van den Bulk S, Petrus AHJ, Willemsen RTA, Boogers MJ, Meeder JG, et al. Ruling out acute coronary syndrome in primary care with a clinical decision rule and a capillary, high-sensitive troponin I point of care test: study protocol of a diagnostic RCT in the Netherlands (POB HELP). BMJ Open, 2023.PMID 37290947
- [13]Druilhe L, Creusier L, Pasco J, Eloi J, Furet V, et al. Evaluating the Efficacy of the Marburg Heart Score to Triage Patients Presenting With Chest Pain in an Emergency Department: A Prospective, Multicenter, Observational Study. Emerg Med Int, 2025.PMID 40432912
- [15]Manten A, Melessen IMB, Himmelreich JCL, Moll van Charante EP, Harskamp RE Marburg Heart Score and INTERCHEST score for telephone triage of acute chest pain: a prospective, diagnostic accuracy study in out-of-hours primary care. BMJ Open, 2026.PMID 41946552
- [16]Mahler SA, Ashburn NP, Villenthi A, Pearson DA, Pugh HD, et al. Validation of a 0/2-Hour Point-Of-Care High Sensitivity Troponin Algorithm: A Multisite US Study. Acad Emerg Med, 2026.PMID 42470147
- [17]Capodifoglio S, De Iuliis V Diagnostic accuracy of point-of-care high-sensitivity troponin algorithms for emergency department rule-out and rule-in of acute myocardial infarction: a systematic review and meta-analysis. Emerg Med J, 2026.PMID 42481217