Last reviewed: March 2020
Last updated: February  2020

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
  • advanced age

Diagnostic investigations

1st investigations to order

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

Investigations to consider

  • arterial blood gas
  • chest x-ray
  • transthoracic echocardiogram
Full details

Emerging tests

  • cardiac myosin-binding protein C (cMyC)
Full details

Treatment algorithm

Contributors

Expert advisersVIEW ALL

NIHR Clinical Lecturer in Interventional Cardiology

Brighton and Sussex Medical School 

Honorary Interventional Cardiology Fellow 

Royal Sussex County Hospital

Brighton

UK

Disclosures

AM is Section Editor, BMJ Best Practice. AM declares that he has no competing interests. 

ST4 in Renal Medicine

Leeds Teaching Hospitals NHS Trust

Leeds

UK

Disclosures

None declared.

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

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

MLA and SG declare that they have no competing interests.

Peer reviewersVIEW ALL

Honorary Professor of Interventional Cardiology

University of Leicester

Consultant Cardiologist

University Hospitals of Leicester NHS Trust

Leicester

UK

Disclosures

None declared.

Section Editor, BMJ Best Practice

Consultant Cardiologist and Electrophysiologist 

Royal Brompton and Harefield Hospitals

London

UK

Disclosures

SH declares that he has no competing interests.

Head of Editorial, BMJ Knowledge Centre

Disclosures

JH declares that she has no competing interests.

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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