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Chronic coronary disease

Последний просмотренный: 19 Aug 2025
Last updated: 11 Nov 2024

Резюме

定义

病史和体格检查

关键诊断因素

  • typical angina symptoms
  • atypical angina symptoms
  • symptoms of low-risk unstable angina
  • normal exam
完整详情

其他诊断因素

  • known medical history of exacerbating factor
  • nonanginal chest pain
  • epigastric discomfort
  • jaw pain
  • arm pain
  • dyspnea on exertion
  • nausea/vomiting
  • perspiration (diaphoresis)
  • fatigue
  • hypoxia
  • tachycardia
  • S3
  • mitral regurgitation murmur
  • bibasilar rales
  • aortic outflow murmur
  • carotid bruit
  • diminished peripheral pulses
  • signs of abdominal aortic aneurysm
  • retinopathy seen on fundoscopic examination
  • xanthomas or xanthelasma
完整详情

危险因素

  • age and sex
  • smoking
  • hypertension
  • dyslipidemia
  • diabetes
  • inactivity
  • diet
  • race, ethnicity, geography
  • psychosocial factors and social determinants of health
  • chronic kidney disease (CKD)
  • inflammatory and other diseases
  • obesity
  • substance misuse
  • family history of coronary disease
  • pollution
完整详情

诊断性检查

首要检查

  • resting ECG
  • hemoglobin
  • lipid profile
  • fasting blood glucose or HbA1c
完整详情

需考虑的检查

  • coronary CT angiography (CCTA)
  • exercise or pharmacologic stress with imaging
  • exercise ECG (without imaging)
  • invasive coronary angiography
  • thyroid function tests
  • CXR
  • rest echocardiography
完整详情

新兴检查

  • CT myocardial perfusion (CTP) and fractional flow reserve CT (FFRCT)
  • coronary artery calcium (CAC) scoring
  • tests for vasospasm and microcirculatory dysfunction

治疗流程

持续性治疗

all patients

撰稿人

作者

Douglas Berger, MD, MLitt

General Medicine Service

Veterans Affairs (VA) Puget Sound Health Care System

Associate Professor

University of Washington

Seattle

WA

利益声明

DB declares that he has no competing interests.

Stephan D. Fihn, MD, MPH

Professor of Medicine and Health Services

University of Washington

Seattle

WA

利益声明

SDF declares that he has no competing interests.

鸣谢

Dr Douglas Berger and Dr Stephan D. Fihn would like to gratefully acknowledge Dr Karen E. Segerson, Dr Mark C. Zaros, Dr Joy Bucher, and Dr Steven M. Bradley, previous contributors to this topic.

利益声明

KES, MCZ, JB, and SMB declare that they have no competing interests.

同行评议者

Syed Wamique Yusuf, MD, MRCPI, FACC

Associate Professor

University of Texas MD Anderson Cancer Center

Department of Cardiology

Houston

TX

利益声明

SWY declares that he has no competing interests.

John R. Charpie, MD, PhD

Associate Professor of Pediatrics

Medical Director

Pediatric Cardiothoracic Intensive Care Unit

University of Michigan Congenital Heart Center

C.S. Mott Children's Hospital

Ann Arbor

MI

利益声明

JRC declares that he has no competing interests.

Michael A. Spinelli, MD

Fellow

Albert Einstein College of Medicine

Montefiore Medical Center

Bronx

NY

Disclosures

MAS declares that he has no competing interests.

Katherine Wu, MD

Associate Professor of Medicine

Division of Cardiology

Johns Hopkins Medical Institutions

Baltimore

MD

Disclosures

KW declares that she has no competing interests.

Daniel Lenihan, MD

Professor of Cardiovascular Medicine

Director of Clinical Research

Vanderbilt University

Nashville

TN

Disclosures

DL declares that he has no competing interests.

Gianluca Rigatelli, MD, PhD, FACP, FACC, FESC, FSCAI

Director

Section of Transcatheter Treatment of Congenital Heart Disease in the Adult

Rovigo General Hospital

Rovigo

Italy

Disclosures

GR declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Knuuti J, Wijns W, Saraste A, et al. 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020 Jan 14;41(3):407-77.Full text  Abstract

Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2021 Nov 30;144(22):e368-454.Full text  Abstract

Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: a report of the American Heart Association/American College of Cardiology joint committee on clinical practice guidelines. Circulation. 2023 Aug 29;148(9):e9-119.Full text  Abstract

Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation. 2019 Jun 18;139(25):e1082-143.Full text  Abstract

Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Thorac Cardiovasc Surg. 2016 Nov;152(5):1243-75. Abstract

Reference articles

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    • 2022 ACC expert consensus decision pathway for integrating atherosclerotic cardiovascular disease and multimorbidity treatment: a framework for pragmatic, patient-centered care: a report of the American College of Cardiology Solution Set Oversight Committee
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  • Patient information

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