[2010] 1.2.1.11 Refer people to hospital as an emergency if they have a recent (confirmed or suspected) ACS and develop further chest pain. [2010] 1.2.1.12 When an ACS is suspected, start management immediately in the order appropriate to the circumstances (see the section on immediate management of a suspected acute coronary syndrome) and take a resting 12-lead ECG (see the section on resting 12-lead ECG). Take the ECG as soon as possible, but do not delay transfer to hospital. [2010] 1.2.1.13 If an ACS is not suspected, consider other causes of the chest pain, some of which may be life-threatening (see recommendations 1.2.6.5, 1.2.2.1 Take a resting 12-lead ECG as soon as possible. When people are referred, send the results to hospital before they arrive if possible. Recording and sending the ECG should not delay transfer to hospital. 1.2.2.2 Follow local protocols for people with a resting 12-lead ECG showing regional ST-segment elevation or presumed new left bundle branch block (LBBB) consistent with an acute STEMI until a firm diagnosis is made. Continue to monitor (see recommendation 1.2.3.4). [2010] 1.2.2.3 Follow the NICE guideline on acute coronary syndromes for people with a resting 12-lead ECG showing regional ST-segment depression or deep T wave inversion suggestive of a NSTEMI or unstable angina until a firm diagnosis is made. Continue to monitor (see recommendation 1.2.3.4). 1.2.2.4 Even in the absence of ST-segment changes, have an increased suspicion of an ACS if there are other changes in the resting 12-lead ECG, specifically Q waves and T wave changes. Consider following the NICE guideline on acute coronary syndromes if these conditions are likely. Continue to monitor (see recommendation 1.2.3.4). [2010] 1.2.2.5 Do not exclude an ACS when people have a normal resting 12-lead ECG. 