Last reviewed: June 2019
Last updated: July  2019

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
  • overweight and obesity
  • physical inactivity
  • male sex
  • albuminuria
  • elevated C-reactive protein
  • strong family history of cardiovascular disease (CVD)

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
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Internal Medicine Resident

Northwestern University

Chicago

IL

Disclosures

AM declares that he has no competing interests.

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.

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.

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.

Peer reviewers VIEW ALL

Assistant Professor

Chicago Medical School

Rosalind Franklin University

Lombard

IL

Disclosures

IM declares that he has no competing interests.

Medical Director

Hines VA Hospital

Hines

IL

Disclosures

DL declares that he has no competing interests.

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