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
1st investigations to order
- HbA1c
- lipid profile
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
acute myocardial infarction
highly significant coronary artery disease: without acute myocardial infarction
diabetic cardiovascular disease: stable and/or after intervention
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.
Differentials
- Unstable angina
- ST-elevation myocardial infarction (STEMI)
- Non-ST-elevation myocardial infarction (NSTEMI)
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