Resumo
Definição
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
Divulgaciones
SWY declares that he has no competing interests.
Agradecimientos
Dr Syed Wamique Yusuf would like to gratefully acknowledge Dr Iyad N. Daher, the previous contributor to this topic.
Divulgaciones
IND declares that he has no competing interests.
Revisores por pares
John Charpie, MD, PhD
Associate Professor of Pediatrics
Medical Director
Pediatric Cardiothoracic Intensive Care Unit
University of Michigan Congenital Heart Center
Ann Arbor
MI
Divulgaciones
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
Divulgaciones
ZI declares that he has no competing interests.
Helge Mollmann, MD
Kerckhoff Heart and Thorax Center
Bad Nauheim
Germany
Divulgaciones
HM declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
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 Resumen
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 Resumen
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 Resumen
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 Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Stable angina
- Prinzmetal (variant or vasospastic) angina
- Non-ST-elevation myocardial infarction
Más DiferencialesGuías de práctica clínica
- 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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