Last reviewed: 19 Sep 2021
Last updated: 05 Oct 2021

Summary

Definition

History and exam

Key diagnostic factors

  • chest pain
  • risk factors for cardiovascular disease

Other diagnostic factors

  • marked sweating
  • epigastric pain
  • dyspnoea
  • syncope
  • back pain

Risk factors

  • diabetes mellitus
  • hyperlipidaemia
  • hypertension
  • metabolic syndrome
  • renal impairment
  • peripheral arterial disease
  • history of ischaemic heart disease and any previous treatment
  • obesity
  • advanced age
  • smoking
  • cocaine use
  • physical inactivity
  • family history of premature coronary artery disease

Diagnostic investigations

1st investigations to order

  • ECG
  • high-sensitivity troponin
  • chest x-ray
  • full blood count
  • urea, electrolytes, and creatinine
  • liver function tests
  • blood glucose
  • C-reactive protein (CRP)

Investigations to consider

  • echocardiography
  • invasive coronary angiography
  • functional (stress) testing
  • coronary computed tomography angiography

Treatment algorithm

Contributors

Expert advisers

Resham Baruah, MBBS, BSc MRCP, PhD

Consultant Cardiologist

Chelsea and Westminster Hospital NHS Foundation Trust

Royal Brompton & Harefield NHS Foundation Trust

London

UK

Biography

RB is specialist advisor to the 2018 NICE guideline on chronic heart failure in adults and is a member of the European Heart Failure Association Task Force on palliative care in heart failure.

Disclosures

RB has received honoraria/speakers’ fees from Novartis and Boehringer Ingelheim.

Adam D. Hartley, MBBS, BSc, MRCP

Wellcome Trust Clinical Research Fellow

Imperial College London

Specialist Registrar in Cardiology

Imperial College Healthcare NHS Trust

London

UK

Disclosures

ADH declares that he has no competing interests.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:

Syed Wamique Yusuf, MBBS, FRCPI

Professor of Medicine

Department of Cardiology

University of Texas

MD Anderson Cancer Center

Houston

TX

Peer reviewers

Gavin Galasko, BM, BCh, MA, DM (Oxon), FRCP

Consultant Interventional Cardiologist

Director of Research, Development and Innovation

Blackpool Teaching Hospitals NHS Foundation Trust

Blackpool

UK

Disclosures

GG declares that he has no competing interests.

Gregory Lip, MD, FRCP, DFM, FACC, FESC, FEHRA

Price-Evans Professor of Cardiovascular Medicine

University of Liverpool

Senior Investigator

National Institute for Health Research

Consultant Cardiologist

Liverpool Heart & Chest Hospital NHS Trust

Liverpool

UK

Distinguished Professor

Faculty of Medicine

Aalborg University

Denmark

Adjunct Professor

Yonsei University

Seoul

South Korea

Disclosures

GL is a consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo. He is a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are directly received personally.

Editors

Annabel Sidwell,

Section Editor, BMJ Best Practice

Disclosures

AS declares that she has no competing interests.

Susan Mayor,

Lead Section Editor, BMJ Best Practice

Disclosures

SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice

Disclosures

RW declares that she has no competing interests.

Tannaz Aliabadi-Oglesby,

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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