Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- Dor torácica
Other diagnostic factors
- diaforese
- dor epigástrica
- dispneia
- náuseas e vômitos
- sopro carotídeo
- pulsos periféricos reduzidos ou ausentes
- síncope
- dorsalgia
- arritmias
- bulhas cardíacas anormais
- estertores
Risk factors
- tabagismo
- hipertensão
- diabetes mellitus
- obesidade e síndrome metabólica
- comportamento sedentário e inatividade física
- dislipidemia
- doença renal crônica (DRC)
- aterosclerose (história de angina, IAM, AVC, ataque isquêmico transitório, doença vascular periférica)
- história familiar de DAC prematura
- idade >60 anos
- uso de cocaína
- depressão
- apneia do sono
- Níveis elevados de proteína C-reativa
- radiação do mediastino
- enxaqueca
- desfechos adversos da gestação
Diagnostic tests
1st tests to order
- eletrocardiograma (ECG)
- biomarcadores cardíacos
- radiografia torácica
- Hemograma completo
- eletrólitos e função renal
- TFHs
- glicemia
- proteína C-reativa
- perfil lipídico
- perfil de coagulação
Tests to consider
- ecocardiograma
- angiografia coronariana
- teste funcional (de estresse)
- angiotomografia coronária
- tomografia computadorizada (TC) do tórax ou ressonância nuclear magnética (RNM)
Treatment algorithm
dor torácica presumivelmente cardíaca
síndrome coronariana aguda sem supradesnivelamento do segmento ST
pós-estabilização: angina instável (AI) confirmada (biomarcadores cardíacos não elevados)
Contributors
Authors
Syed Wamique Yusuf, MBBS, FRCPI
Professor of Medicine
Department of Cardiology
University of Texas
MD Anderson Cancer Center
Houston
TX
Disclosures
SWY declares that he has no competing interests.
Acknowledgements
Dr Syed Wamique Yusuf would like to gratefully acknowledge Dr Iyad N. Daher, the previous contributor to this topic.
Disclosures
IND declares that he has no competing interests.
Peer reviewers
John Charpie, MD, PhD
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.
Zaza Iakobishvili, MD, PhD
Director
Emergency Cardiac Service ICCU
Department of Cardiology
Rabin Medical Center
Petah Tikva
Israel
Disclosures
ZI declares that he has no competing interests.
Helge Mollmann, MD
Kerckhoff Heart and Thorax Center
Bad Nauheim
Germany
Disclosures
HM declares that he has no competing interests.
References
Key articles
Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J. 2023 Oct 12;44(38):3720-826.Full text Abstract
Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Dec 23;64(24):e139-228.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. J Am Coll Cardiol. 2021 Nov 30;78(22):e187-285.Full text Abstract
Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Jan 18;145(3):e18-114.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Angina estável
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