Summary
Definition
History and exam
Key diagnostic factors
- chest pain
- dyspnea on exertion
- hypotension
- rales
- S3 gallop
- hypertension
- 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 edema
- smooth shiny skin with hair loss
- pallor
Risk factors
- cigarette smoking
- hypertension
- dyslipidemia
- poor glycemic control
- physical inactivity
- overweight and obesity
- albuminuria
- chronic kidney disease (CKD)
- elevated C-reactive protein
- family history of CVD
- female sex
- gestational diabetes
- mental illness
- metabolic dysfunction-associated steatotic liver disease (previously nonalcoholic fatty liver disease)
- suboptimal sleep
- atrial fibrillation
Diagnostic investigations
1st investigations to order
- HbA1c
- lipid profile
Investigations to consider
- B natriuretic peptide (BNP)/N-terminal prohormone B-natriuretic peptide (NT-proBNP)
- transthoracic doppler echocardiogram
- exercise ECG
- exercise (stress) imaging test
- pharmacologic (stress) imaging test
- cardiac MRI or stress cardiac MRI
- ankle-brachial index (ABI)
- CT coronary angiography
- CT coronary calcium scan
- invasive coronary angiography
- noncontrast head CT
- brain MRI
- duplex ultrasonography of carotid arteries
- C-reactive protein
- chest x-ray
Treatment algorithm
acute myocardial infarction or unstable angina
highly significant coronary artery disease: without acute myocardial infarction or unstable angina
diabetic cardiovascular disease: stable and/or after intervention
Contributors
Authors
Mohamed Al-Kazaz, MD
Assistant Professor of Medicine (Cardiology)
Section Chief, General Cardiology
Division of Cardiology, Department of Medicine
Northwestern University Feinberg School of Medicine
Bluhm Cardiovascular Institute
Northwestern Memorial Hospital
Chicago
IL
Disclosures
MA has received research grants from Kiniksa Pharmaceuticals, Ventyx BioSciences, and Cardiol Therapeutics. He has also received speaking honoraria from Kiniksa Pharmaceuticals and consulting fees from Edwards Lifesciences.
Acknowledgements
Dr Mohamed Al-Kazaz would like to gratefully acknowledge Dr Alexander Meyer, Dr Laura Davidson, Dr Charles Davidson, and Dr Leonard E. Egede, the previous contributors to this topic, and would like to gratefully acknowledge the review by Dr Shreenidhi Venuraju, MB BS, MRCP, Wellington Hospital South, UK.
Disclosures
AM, LD, CD, and LE declare that they have no competing interests. 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
Declarações
DL declares that he has no competing interests.
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Referências
Principais artigos
Marx N, Federici M, Schütt K, et al. 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023 Oct 14;44(39):4043-140.Texto completo Resumo
American Diabetes Association. Standards of care in diabetes - 2025. Diabetes Care. 2025 Jan 1;48(suppl 1):S14-352.Texto completo
Joseph JJ, Deedwania P, Acharya T, et al. Comprehensive management of cardiovascular risk factors for adults with type 2 diabetes: a scientific statement from the American Heart Association. Circulation. 2022 Mar;145(9):e722-59.Texto completo Resumo
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-248.Texto completo Resumo
Writing Committee Members; 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. J Am Coll Cardiol. 2022 Jan 18;79(2):e21-129.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Unstable angina
- ST-elevation myocardial infarction (STEMI)
- Non-ST-elevation myocardial infarction (NSTEMI)
Mais Diagnósticos diferenciaisDiretrizes
- 2025 guideline for the management of patients with acute coronary syndromes
- American Association of Clinical Endocrinology clinical practice guideline on pharmacologic management of adults with dyslipidemia
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