Summary
Definition
History and exam
Key diagnostic factors
- Chest pain
Other diagnostic factors
- diaphoresis
- epigastric pain
- dyspnea
- nausea and vomiting
- carotid bruit
- diminished or absent peripheral pulses
- syncope
- back pain
- arrhythmias
- abnormal heart sounds
- rales
Risk factors
- smoking
- hypertension
- diabetes mellitus
- obesity and metabolic syndrome
- sedentary behavior and physical inactivity
- dyslipidemia
- chronic kidney disease (CKD)
- atherosclerosis (history of angina, MI, stroke, transient ischemic attack, peripheral vascular disease)
- family history of premature CAD
- age >60 years
- cocaine use
- depression
- sleep apnea
- elevated C-reactive protein levels
- mediastinal radiation
- migraine
- adverse pregnancy outcomes
Diagnostic tests
1st tests to order
- ECG
- cardiac biomarkers
- CXR
- CBC
- electrolytes and renal function
- LFTs
- blood sugar
- CRP
- lipid profile
- coagulation profile
Tests to avoid
- coronary artery calcium (CAC)
Tests to consider
- echocardiogram
- coronary angiography
- functional (stress) testing
- coronary CT angiography
- CT chest or MRI
Treatment algorithm
presumed cardiac chest pain
non-ST-elevation acute coronary syndrome
poststabilization: confirmed UA (nonelevated cardiac biomarkers)
Contributors
Authors
Syed Wamique Yusuf, MBBS, FRCPI

Professor of Medicine
Department of Cardiology
University of Texas
MD Anderson Cancer Center
Houston
TX
Disclosures
SWY declares that he has no competing interests.
Acknowledgements
Dr Syed Wamique Yusuf would like to gratefully acknowledge Dr Iyad N. Daher, the previous contributor to this topic.
Disclosures
IND declares that he has no competing interests.
Peer reviewers
John Charpie, MD, PhD
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.
Zaza Iakobishvili, MD, PhD
Director
Emergency Cardiac Service ICCU
Department of Cardiology
Rabin Medical Center
Petah Tikva
Israel
Disclosures
ZI declares that he has no competing interests.
Helge Mollmann, MD
Kerckhoff Heart and Thorax Center
Bad Nauheim
Germany
Disclosures
HM declares that he has no competing interests.
Differentials
- Stable angina
- Prinzmetal (variant or vasospastic) angina
- Non-ST-elevation myocardial infarction
More DifferentialsGuidelines
- 2023 ESC guidelines for the management of acute coronary syndromes
- European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) Expert Consensus Statement on the state of genetic testing for cardiac diseases
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Thrombolysis in Myocardial Infarction (TIMI) Score for Unstable Angina Non ST Elevation Myocardial Infarction
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