Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • typical angina symptoms
  • atypical angina symptoms
  • symptoms of low-risk unstable angina
  • normal examination

Other diagnostic factors

  • known medical history of exacerbating factor
  • non-anginal chest pain
  • epigastric discomfort
  • jaw pain
  • arm pain
  • dyspnoea on exertion
  • nausea/vomiting
  • perspiration (diaphoresis)
  • fatigue
  • hypoxia
  • tachycardia
  • S3
  • mitral regurgitation murmur
  • bibasilar rales
  • aortic outflow murmur
  • carotid bruit
  • diminished peripheral pulses
  • signs of abdominal aortic aneurysm
  • retinopathy seen on fundoscopic examination
  • xanthomas or xanthelasma

Risk factors

  • advancing age
  • smoking
  • hypertension
  • elevated LDL cholesterol
  • isolated low HDL cholesterol
  • hypertriglyceridaemia
  • diabetes
  • inactivity
  • obesity
  • family history of premature ischaemic heart disease
  • illicit drug use
  • male sex
  • mental stress/depression
  • plasma biomarkers
  • polluted air

Diagnostic investigations

1st investigations to order

  • resting ECG
  • haemoglobin
  • fasting lipid profile
  • fasting blood glucose
Full details

Investigations to consider

  • TSH
  • haemoglobin A1C
  • stress exercise ECG without imaging
  • stress myocardial perfusion imaging
  • stress echocardiography
  • coronary angiography
  • echocardiography
  • cardiac computed tomographic angiography (CCTA)
  • cardiac magnetic resonance (CMR)
Full details

Emerging tests

  • coronary artery calcium scoring
  • cardiac positron emission tomography (PET) scan
  • fractional flow reserve (FFR)-CT and FFR-MRI
Full details

Treatment algorithm

ONGOING

Contributors

Authors VIEW ALL

Assistant Professor

University of Washington Medical Center

University of Washington

Seattle

WA

Disclosures

KES declares that she has no competing interests.

Dr Karen E Segerson would like to gratefully acknowledge Dr Stephan D. Fihn , Dr Mark C. Zaros, Dr Joy Bucher, and Dr Steven M. Bradley, previous contributors to this topic. SDF, MCZ, JB, and SMB declare that they have no competing interests.

Peer reviewers VIEW ALL

Associate Professor

University of Texas MD Anderson Cancer Center

Department of Cardiology

Houston

TX

Disclosures

SWY declares that he has no competing interests.

Associate Professor of Pediatrics

Medical Director

Pediatric Cardiothoracic Intensive Care Unit

University of Michigan Congenital Heart Center

C.S. Mott Children's Hospital

Ann Arbor

MI

Disclosures

JRC declares that he has no competing interests.

Fellow

Albert Einstein College of Medicine

Montefiore Medical Center

Bronx

NY

Disclosures

MAS declares that he has no competing interests.

Associate Professor of Medicine

Division of Cardiology

Johns Hopkins Medical Institutions

Baltimore

MD

Disclosures

KW declares that she has no competing interests.

Professor of Cardiovascular Medicine

Director of Clinical Research

Vanderbilt University

Nashville

TN

Disclosures

DL declares that he has no competing interests.

Director

Section of Transcatheter Treatment of Congenital Heart Disease in the Adult

Rovigo General Hospital

Rovigo

Italy

Disclosures

GR declares that he has no competing interests.

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