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
- smoking
- hypertension
- diabetes mellitus
- obesity and metabolic syndrome
- sedentary behaviour and physical inactivity
- dyslipidaemia
- chronic kidney disease
- atherosclerosis (history of angina, myocardial infarction, stroke, transient ischaemic attack, peripheral vascular disease)
- family history of premature coronary artery disease
- age >60 years
- cocaine use
- depression
- stent thrombosis or restenosis
- sleep apnoea
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
suspected or confirmed unstable angina
post-stabilisation
Contributors
Expert advisers
Shrilla Banerjee, MD, FRCP
Consultant Interventional Cardiologist
East Surrey Hospital
Surrey and Sussex Healthcare NHS Trust
UK
Disclosures
SB has received speaker fees for educational lectures (presentation content was her own) and meeting participation from Menarini, Edwards Lifesciences, Abbott Vascular, and Shockwave IVL. She has also participated in an Advisory Board for Sahajanand Medical Technologies Limited. SB has received travel sponsorship from Biosensors International to attend the PCR meeting in Paris in 2022. She has prepared a manuscript on coronary microvascular dysfunction for Abbott for Cardiovascular News (no royalties).
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.
Moad El-Haddad, MBBCh, MRCP
Associate Specialist in Cardiology
East Surrey Hospital
Surrey and Sussex Healthcare NHS Trust
UK
Disclosures
MEH declares that he has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:
Resham Baruah MBBS, BSc MRCP, PhD
Consultant Cardiologist
Chelsea and Westminster Hospital NHS Foundation Trust
Royal Brompton & Harefield NHS Foundation Trust
London
UK
Syed Wamique Yusuf, MBBS, FRCPI
Professor of Medicine
Department of Cardiology
University of Texas
MD Anderson Cancer Center
Houston
TX
Disclosures: RB has received honoraria/speakers' fees from Novartis and Boehringer Ingelheim. SWY declares that he has no competing interests.
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.
Differentials
- Stable angina
- Prinzmetal (variant or vasospastic) angina
- Non-ST-elevation myocardial infarction
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