Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • chest pain
  • diaphoresis
  • recent percutaneous coronary intervention (PCI) or previous CABG

Other diagnostic factors

  • physical exertion
  • shortness of breath
  • weakness
  • anxiety
  • nausea
  • vomiting
  • abdominal pain
  • hypertension
  • cold exposure
  • emotional upset
  • early morning onset
  • syncope
  • hypotension
  • arrhythmias
  • abnormal heart sounds

Risk factors

  • atherosclerosis (hx of angina, MI, stroke, TIA, PVD)
  • diabetes
  • smoking
  • dyslipidaemia
  • family history of premature coronary heart disease (CAD)
  • age >65 years
  • hypertension
  • obesity and metabolic syndrome phenotype
  • physical inactivity
  • cocaine use
  • depression
  • stent thrombosis or restenosis
  • chronic kidney disease
  • surgical procedures (including intra-operative and postoperative periods)

Diagnostic investigations

1st investigations to order

  • ECG
  • trial of sublingual glyceryl trinitrate
  • cardiac troponins
  • creatine kinase (CK)
  • CK-MB (cardiac isoforms)
  • FBC
  • urea and serum creatinine
  • electrolytes
  • liver function tests
  • blood glucose
  • CXR
Full details

Investigations to consider

  • lipids
  • brain natriuretic peptide (BNP) or N-terminal pro-BNP (NT-pro-BNP)
  • echocardiography
  • angiography
  • stress testing
  • coronary CT angiography (CCTA)
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Associate Professor of Medicine

Director of Research, Cardiac Catheterization Laboratory

Director, Cardiovascular Outcomes Group Department of Medicine

New York University School of Medicine

NY

Disclosures

SB declares that he has no competing interests.

Fellow

Division of Cardiology

New York University School of Medicine

NY

Disclosures

MO declares that she has no competing interests.

Dr Sripal Bangalore and Dr Mina Owlia would like to gratefully acknowledge Dr Thomas Vanhecke and Dr Dena Krishnan, the previous contributors to this monograph. TEV and DK declare that they have no competing interests.

Peer reviewers VIEW ALL

Associate Professor

Department of Emergency Medicine

Beth Israel Medical Deaconess Center

Boston

MA

Disclosures

EU declares that he has no competing interests.

Associate Professor of Medicine

Department of Cardiovascular Medicine

Cleveland Clinic

OH

Disclosures

DLB declares that he has no competing interests.

Consultant Cardiologist

East Surrey Hospital

Surrey and Sussex NHS Trust

Surrey

UK

Disclosures

SB declares that she has no competing interests.

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