Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • increasing frequency of chest pain
  • increasing severity of chest pain
  • retrosternal chest pain radiating to jaw, arm, or neck
  • dyspnea
  • fourth heart sound (S4)

Other diagnostic factors

  • atypical chest discomfort
  • diaphoresis
  • nausea
  • tachycardia
  • carotid bruit
  • poor peripheral pulses
  • syncope
  • third heart sound (S3)
  • murmur
  • rales

Risk factors

  • female sex
  • personal hx of CAD
  • increased age
  • FHx of CAD
  • hypertension
  • smoking
  • diabetes mellitus
  • hyperlipidemia
  • peripheral vascular disease
  • obesity/lack of exercise
  • chronic kidney disease
  • elevated CRP levels
  • mediastinal radiation
  • high altitude

Diagnostic investigations

1st investigations to order

  • ECG
  • cardiac biomarkers
  • CBC
  • electrolytes and renal function
  • blood sugar
  • lipid profile
  • coagulation profile
  • CXR
  • echo: rest
  • myocardial perfusion study: rest
  • CT chest or MRI
  • coronary angiography
Full details

Investigations to consider

  • echo: stress
  • myocardial perfusion study: stress
  • coronary CT angiography
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Syed Wamique Yusuf

Associate Professor of Medicine

Department of Cardiology

University of Texas

MD Anderson Cancer Center

Houston

TX

Disclosures

SWY declares that he has no competing interests.

Dr Syed Wamique Yusuf would like to gratefully acknowledge Dr Iyad N. Daher, the previous contributor to this monograph. IND declares that he has no competing interests.

Peer reviewers VIEW ALL

Associate Professor of Pediatrics

Medical Director

Pediatric Cardiothoracic Intensive Care Unit

University of Michigan Congenital Heart Center

Ann Arbor

MI

Disclosures

JC declares that he has no competing interests.

Director

Emergency Cardiac Service ICCU

Department of Cardiology

Rabin Medical Center

Petah Tikva

Israel

Disclosures

ZI declares that he has no competing interests.

Kerckhoff Heart and Thorax Center

Bad Nauheim

Germany

Disclosures

HM declares that he has no competing interests.

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