Last reviewed: 19 Sep 2021
Last updated: 06 Oct 2021

Summary

Definition

History and exam

Key diagnostic factors

  • chest pain
  • dyspnoea
  • pallor
  • diaphoresis
  • cardiac risk factors
  • abnormal breath sounds
  • additional heart sounds
  • cardiogenic shock

Other diagnostic factors

  • nausea and/or vomiting
  • dizziness or light-headedness
  • distress and anxiety
  • palpitations
  • reduced consciousness
  • hypotension
  • atypical location or nature of pain

Risk factors

  • smoking
  • hypertension
  • diabetes
  • obesity
  • metabolic syndrome
  • physical inactivity
  • dyslipidaemia
  • renal insufficiency
  • established coronary artery disease
  • family history of premature coronary artery disease
  • cocaine use
  • male sex
  • age >50 years

Diagnostic investigations

1st investigations to order

  • ECG
  • coronary angiography
  • cardiac troponin
  • glucose
  • full blood count
  • electrolytes, urea, creatinine, and estimated glomerular filtration rate (eGFR)
  • C-reactive protein (CRP)
  • serum lipids

Investigations to consider

  • arterial blood gas
  • chest x-ray
  • point-of-care transthoracic echocardiogram

Emerging tests

  • cardiac myosin-binding protein C (cMyC)

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.

Acknowledgements,

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

Aung Myat

NIHR Clinical Lecturer in Interventional Cardiology

Brighton and Sussex Medical School

Honorary Interventional Cardiology Fellow

Royal Sussex County Hospital

Brighton

UK

Duha Ilyas

ST4 in Renal Medicine

Leeds Teaching Hospitals

NHS Trust Leeds

UK

Mahi L. Ashwath MD, FACC, FASE

Director, Cardiac MRI

Clinical Associate Professor of Medicine and Radiology

Division of Cardiology

Department of Internal Medicine

University of Iowa Hospitals and Clinics

University of Iowa Health Care

Iowa

IA

Sanjay Gandhi MD, FACC, FAHA, FSCAI

Director, Endovascular Cardiology

Associate Professor of Medicine, Endovascular Cardiology

Case Western Reserve University

Cleveland

OH

Disclosures

AM, MLA, and SG declare that they have 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.

Anthony Gershlick,

Honorary Professor of Interventional Cardiology

University of Leicester

Consultant Cardiologist

University Hospitals of Leicester NHS Trust

Leicester

UK

Disclosures

At the time of review, AG did not declare any competing interests. Unfortunately, we have since been made aware that AG has passed away.

Editors

Helena Delgado-Cohen,

Section Editor, BMJ Best Practice

Disclosures

HDC declares that she has no competing interests.

Jo Haynes,

Head of Editorial, BMJ Knowledge Centre

Disclosures

JH 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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