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
- elevated C-reactive protein
- family history of cardiovascular disease
- female sex
- gestational diabetes
Diagnostic investigations
1st investigations to order
- HbA1c
- lipid profile
Investigations to consider
- transthoracic Doppler echocardiogram
- exercise ECG
- exercise imaging test
- pharmacologic imaging test
- cardiac MRI or stress cardiac myocardial perfusion imaging
- ankle-brachial index (ABI)
- CT angiography
- 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)
Northwestern University Feinberg School of Medicine
Bluhm Cardiovascular Institute
Northwestern Memorial Hospital
Chicago
IL
Disclosures
MA declares that he has no competing interests.
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
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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