Last reviewed: November 2017
Last updated: November  2017



History and exam

Key diagnostic factors

  • presence of risk factors
  • chest pain
  • dyspnoea on exertion
  • hypotension
  • rales
  • S3 gallop
  • BP >140/90 mmHg
  • nausea
  • diaphoresis
  • tachycardia
  • indigestion

Other diagnostic factors

  • unilateral weakness, numbness, and/or tingling
  • headache
  • intermittent claudication
  • bruits
  • aphasia
  • hemisensory loss
  • cranial nerve palsies
  • seizures
  • vertigo
  • limb pain at rest
  • diminished/absent lower extremity pulses
  • ulcers or gangrene
  • peripheral oedema
  • smooth shiny skin with hair loss
  • pallor

Risk factors

  • cigarette smoking
  • hypertension (HTN)
  • dyslipidaemia
  • poor glycaemic control
  • overweight and obesity
  • physical inactivity
  • male gender
  • albuminuria
  • elevated C-reactive protein
  • strong family history of CVD

Diagnostic investigations

1st investigations to order

  • HbA1c
  • fasting lipid profile
Full details

Investigations to consider

  • exercise stress test
  • treadmill or pharmacological stress echocardiogram
  • treadmill or pharmacological myocardial perfusion scanning
  • ankle-brachial index (ABI)
  • CT angiography
  • coronary angiography
  • non-contrast head CT
  • MRI brain
  • duplex ultrasonography of carotid arteries
  • C-reactive protein
Full details

Treatment algorithm


Authors VIEW ALL

Cardiology Fellow

Northwestern University




LD declares that she has no competing interests.

Clinical Chief

Division of Cardiology

Medical Director

Bluhm Cardiovascular Institute

Northwestern Memorial Hospital

Professor of Medicine

Northwestern University

Feinberg School of Medicine




CD declares that he has no competing interests.

Dr Laura Davidson and Dr Charles Davidson would like to gratefully acknowledge Dr Leonard E. Egede, the previous contributor to this monograph, and would like to gratefully acknowledge the review by Dr Shreenidhi Venuraju, MB BS, MRCP, Wellington Hospital South, UK. LEE is an author of a number of references cited in this monograph. SV not disclosed.

Peer reviewers VIEW ALL

Assistant Professor

Chicago Medical School

Rosalind Franklin University




IM declares that he has no competing interests.

Medical Director

Hines VA Hospital




DL declares that he has no competing interests.

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