Is there a new unexplained change in patient’s typical pain? e.g.

• More frequently, at less exertion

• At rest

• Associated presyncope

• New palpitations, tachy- or bradyarrhythmia

• Other new associated symptoms?

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If any of the above, discuss with Acute GP service (in out of hours, consider RCH admission)

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If none of the above, consider uptitration of anti-anginal medication with or without an outpatient referral to cardiology