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 investigations
1st investigations 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)
Investigations 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
Declarações
ZI declares that he has no competing interests.
Helge Mollmann, MD
Kerckhoff Heart and Thorax Center
Bad Nauheim
Germany
Declarações
HM declares that he has no competing interests.
Créditos aos pareceristas
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Declarações
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Referências
Principais artigos
Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J. 2023 Oct 12;44(38):3720-826.Texto completo Resumo
Rao SV, O'Donoghue ML, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2025 Apr;151(13):e771-862.Texto completo Resumo
Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021 Nov 30;78(22):e187-285.Texto completo Resumo
Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Jan 18;145(3):e18-114.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Stable angina
- Prinzmetal (variant or vasospastic) angina
- Non-ST-elevation myocardial infarction
Mais Diagnósticos diferenciaisDiretrizes
- 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines
- 2023 ESC guidelines for the management of acute coronary syndromes
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