Last reviewed: 25 Jun 2021
Last updated: 08 Mar 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • chest pain
  • dyspnoea on exertion
  • hypotension
  • rales
  • S3 gallop
  • BP >140/90 mmHg
  • nausea
  • diaphoresis
  • tachycardia
  • indigestion

Other diagnostic factors

  • unilateral weakness, numbness, and/or tingling
  • headache
  • intermittent claudication
  • bruits
  • aphasia
  • hemisensory loss
  • cranial nerve palsies
  • seizures
  • vertigo
  • limb pain at rest
  • diminished/absent lower extremity pulses
  • ulcers or gangrene
  • peripheral oedema
  • smooth shiny skin with hair loss
  • pallor

Risk factors

  • cigarette smoking
  • hypertension
  • dyslipidaemia
  • poor glycaemic control
  • physical inactivity
  • albuminuria
  • elevated C-reactive protein
  • strong family history of cardiovascular disease (CVD)
  • overweight and obesity
  • male sex

Diagnostic investigations

Investigations to consider

  • exercise stress test
  • treadmill or pharmacological stress echocardiogram
  • treadmill or pharmacological myocardial perfusion scanning
  • ankle-brachial index (ABI)
  • CT angiography
  • coronary angiography
  • non-contrast head CT
  • MRI brain
  • duplex ultrasonography of carotid arteries
  • C-reactive protein

Treatment algorithm

Contributors

Authors

Alexander Meyer, MD

Cardiovascular Medicine Fellow

Wexner Medical Center

The Ohio State University

Columbus

OH

Disclosures

AM declares that he has no competing interests.

Laura Davidson, MD, MS

Assistant Professor of Medicine

Division of Cardiology

Bluhm Cardiovascular Institute

Northwestern University

Feinberg School of Medicine

Chicago

IL

Disclosures

LD declares that she has no competing interests.

Charles Davidson, MD

Vice Chairman, Clinical Affairs

Department of Medicine

Clinical Chief

Division of Cardiology

Medical Director

Bluhm Cardiovascular Institute

Northwestern Memorial Hospital

Professor of Medicine

Northwestern University

Feinberg School of Medicine

Chicago

IL

Disclosures

CD declares that he has no competing interests.

Acknowledgements

Dr Laura Davidson and Dr Charles Davidson would like to gratefully acknowledge Dr Leonard E. Egede, the previous contributor to this topic, and would like to gratefully acknowledge the review by Dr Shreenidhi Venuraju, MB BS, MRCP, Wellington Hospital South, UK.

Disclosures

LEE is an author of a number of references cited in this topic. SV not disclosed.

Peer reviewers

Irfan Moinuddin, MD

Assistant Professor

Chicago Medical School

Rosalind Franklin University

Lombard

IL

Disclosures

IM declares that he has no competing interests.

David Leehey, MD

Medical Director

Hines VA Hospital

Hines

IL

Disclosures

DL declares that he has no competing interests.

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