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
suspected or clinical diagnosis of STEMI (symptoms of myocardial ischaemia + ST elevation on ECG)
post-STEMI
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 Hartley, MBBS, BSc, MRCP
Wellcome Trust Clinical Research Fellow
Imperial College London
Specialist Registrar in Cardiology
Imperial College Healthcare NHS Trust
London
UK
Disclosures
AH declares that he has no competing interests.
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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