Summary
Definition
History and exam
Key diagnostic factors
- increasing frequency of chest pain
- increasing severity of chest pain
- retrosternal chest pain radiating to jaw, arm, or neck
- dyspnea
- fourth heart sound (S4)
Other diagnostic factors
- atypical chest discomfort
- diaphoresis
- nausea
- tachycardia
- carotid bruit
- poor peripheral pulses
- syncope
- third heart sound (S3)
- murmur
- rales
Risk factors
- female sex
- personal history of coronary artery disease (CAD)
- increased age
- family history of CAD
- hypertension
- smoking
- diabetes mellitus
- hyperlipidemia
- peripheral vascular disease
- obesity/lack of exercise
- chronic kidney disease
- elevated CRP levels
- mediastinal radiation
- high altitude
Diagnostic investigations
1st investigations to order
- ECG
- cardiac biomarkers
- CBC
- electrolytes and renal function
- blood sugar
- lipid profile
- coagulation profile
- CXR
- echo: rest
- myocardial perfusion study: rest
- CT chest or MRI
- coronary angiography
Investigations to consider
- echo: stress
- myocardial perfusion study: stress
- coronary CT angiography
Treatment algorithm
Contributors
Authors VIEW ALL
Professor of Medicine
Department of Cardiology
University of Texas
MD Anderson Cancer Center
Houston
TX
Disclosures
SWY declares that he has no competing interests.
Dr Syed Wamique Yusuf would like to gratefully acknowledge Dr Iyad N. Daher, the previous contributor to this topic. IND declares that he has no competing interests.
Peer reviewers VIEW ALL
Associate Professor of Pediatrics
Medical Director
Pediatric Cardiothoracic Intensive Care Unit
University of Michigan Congenital Heart Center
Ann Arbor
MI
Disclosures
JC declares that he has no competing interests.
Director
Emergency Cardiac Service ICCU
Department of Cardiology
Rabin Medical Center
Petah Tikva
Israel
Disclosures
ZI declares that he has no competing interests.
Kerckhoff Heart and Thorax Center
Bad Nauheim
Germany
Disclosures
HM declares that he has no competing interests.
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