[2010] 1.2.1.2 Determine whether the chest pain may be cardiac and therefore whether this guideline is relevant, by considering: the history of the chest pain the presence of cardiovascular risk factors history of ischaemic heart disease and any previous treatment previous investigations for chest pain. [2010] 1.2.1.3 Initially assess people for any of the following symptoms, which may indicate an ACS: pain in the chest and/or other areas (for example, the arms, back or jaw) lasting longer than 15 minutes chest pain associated with nausea and vomiting, marked sweating, breathlessness, or particularly a combination of these chest pain associated with haemodynamic instability new onset chest pain, or abrupt deterioration in previously stable angina, with recurrent chest pain occurring frequently and with little or no exertion, and with episodes often lasting longer than 15 minutes. [2010] 1.2.1.4 Do not use people's response to glyceryl trinitrate (GTN) to make a 1.2.1.5 Do not assess symptoms of an ACS differently in men and women. Not all people with an ACS present with central chest pain as the predominant 1.2.1.6 Do not assess symptoms of an ACS differently in ethnic groups. There are no major differences in symptoms of an ACS among different ethnic 1.2.1.7 Refer people to hospital as an emergency if an ACS is suspected (see recommendation 1.2.1.3) and: they currently have chest pain or they are currently pain free, but had chest pain in the last 12 hours, and a resting 12-lead ECG is abnormal or not available. 